Correlation between meniscal extrusion and symptom duration, alignment, and arthritic changes in medial meniscus posterior root tear: research article

Background@#Medial meniscus posterior root tear can result in medial meniscus extrusion. However, the severity of medial meniscus extrusion is different in each root tear patient. The purpose of this study was to identify the factors that contribute to the severity of medial meniscus extrusion with medial meniscus posterior root tear, such as duration of disease, the degree of arthritis—chondral wear, subchondral edema, osteophyte size, and Kellgren– Lawrence (K/L) grade—and mechanical alignment for appropriate treatment method. @*Methods@#From January 2009 to August 2014, we retrospectively analyzed magnetic resonance imaging (MRI) and simple x-ray of 99 patients with medial meniscus posterior root tear. The duration of the disease was identified through retrospective chart review. The severity of medial meniscus extrusion, the presence of subchondral edema, the degree of chondral wear, and the size of the osteophyte were measured on MRI. K/L grade was confirmed on simple x-ray, and the mechanical axis was measured on whole extremity radiographs. Statistical analysis was performed by using bivariate correlation analysis and one-way analysis of variance. @*Results@#The mean medial meniscus extrusion was 4.61 mm, and the mean duration of the disease was 15.52 months.The mean degree of chondral wear was 25.8%, and 63 out of 99 cases showed subchondral edema. The average alignment was 4.30 degrees, and the average size of the osteophyte was 1.48 mm. There were 40 cases (40.4%) with K/ L grade I, 48 cases (48.5%) with grade II, 11 cases (11.1%) with grade III, and no cases with grade IV. In the group mean analysis between the K/L grade and the severity of medial meniscus extrusion, the average medial meniscus extrusions were 3.97 mm in grade I, 4.93 mm in grade II, and 5.59 mm in grade III. There was a statistical significance between the size of the osteophyte and the severity of medial meniscus extrusion (P = 0.000), K/L grade, and the severity of medial meniscus extrusion (P = 0.001). @*Conclusions@#The severity of medial meniscus extrusion with medial meniscus posterior horn root tear is associated with the size of the osteophyte and K/L grade.

Results of Exchange Nailing in Hypertrophic Nonunion of Femoral Shaft Fracture Treated with Nailing

PURPOSE: This study examined the outcomes of exchange nailing for the hypertrophic nonunion of femoral shaft fractures treated with intramedullary nailing as well as the factors affecting the treatment outcomes. MATERIALS AND METHODS: From January 1999 to March 2015, 35 patients, who had undergone intramedullary nailing with a femoral shaft fracture and underwent exchange nailing due to hypertrophic nonunion, were reviewed. This study investigated the time of union and complications, such as nonunion after exchange nailing, and analyzed the factors affecting the results. RESULTS: Bone union was achieved in 31 cases (88.6%) after exchange nailing and the average bone union period was 22 weeks (14–44 weeks). Complications included persistent nonunion in four cases, delayed union in one case, and superficial wound infection in one case. All four cases with nonunion were related to smoking, three of them were distal shaft fractures, and one was a midshaft fracture with underlying disease. CONCLUSION: Exchange nailing produced satisfactory results as the treatment of hypertrophic nonunion after intramedullary nailing. Smoking is considered a factor for continuing nonunion even after exchange nailing. In the case of a distal shaft, where the intramedullary fixation is relatively weak, additional efforts are needed for stability.

Comparison of Blood Loss between Intra-Articular and Intravenous Tranexamic Acid Following Primary Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To investigate the difference in blood loss between two injection methods, intravenous (IV) and intra-articular (IA) methods via drain tube. MATERIALS AND METHODS: A total of 183 patients who underwent total knee arthroplasty between October 2013 and March 2016 were included. The method of tranexamic acid (TXA) administration was intravenously injected before August 2015, and it was applied thereafter to the joint through a drainage tube post intra-articular suture. Our subjects were divided into the following groups: The intravenous unilateral (IVU), intravenous bilateral (IVB), intra-articular unilateral (IAU), and intra-articular bilateral (IAB) groups. Hemoglobin and hematocrit, drainage amount, transfusion frequency, mean transfusion volume, and blood loss, as well as complications were compared between the groups. RESULTS: Drainage amount was 558.08±296.29 ml in IVU, and 498.39±199.70 ml in IAU; there was less drainage in IAU than in IVU, but without significance (p=0.262). Moreover, the drainage amount was 1,110.39±396.23 ml in IVB and 827.14±282.47 ml in IAB, which was significantly lower in IAB (p=0.000). Transfusion frequency was 5 patients (10.0%) in IVU and 2 patients (4.5%) in IAU, but without significant difference (p=0.442). Moreover, the frequency was 16 patients (29.6%) in IVB and 1 patient (2.9%) in IAB, which was significantly lower in the IAB group (p=0.002). Mean transfusion volume was 44.80±144.71 ml in IVU and 21.80±106.86 ml in IAU, but without significant difference (p=0.389); the volume was 177.80±321.00 ml in IVB and 18.30±108.18 ml in IAB, with statistical significance (p=0.001). Blood loss was 1,318.70±724.20 ml in IVU and 963.28±454.03 ml in IAU, which was significantly lower in the IAU (p=0.006); blood loss was 1,837.40±699.70 ml in IVB, and 1,337.60±382.20 ml in IAB and it was significantly lower in IAB (p=0.000). Complications included deep vein thrombosis in one case in IVU. CONCLUSION: In TKA, IA injection of TXA significantly reduced blood loss compared with IV injection, especially in bilateral TKA.

Comparison of Blood Loss between Neutral Drainage with Tranexamic Acid and Negative Pressure Drainage without Tranexamic Acid Following Primary Total Knee Arthroplasty

PURPOSE: There are many methods to reduce massive bleeding during total knee arthroplasty (TKA). In our study, tranexamic acid and neutral drainage were used to decrease total blood loss. MATERIALS AND METHODS: The study was performed on 97 TKA patients from March 2012 to January 2013. In the study group, tranexamic acid was administered and neutral drainage was applied. The study group had group I (unilateral, n=29) and group III (bilateral, n=17). The control group had group II (unilateral, n=35) and group IV (bilateral, n=16). RESULTS: In group I, the drainage volume on the 1st and 2nd postoperative days and the total drainage decreased with statistical significance (p<0.05). Between group III and group IV, group III had less drainage volume. In group III, the drainage volume on the 1st postoperative day and total drainage volume decreased statistically significantly (p<0.05). Between groups I and II, total blood loss showed no statistically significant difference, whereas between groups III and IV, the value was significantly different. CONCLUSIONS: Intravenous administration of tranexamic acid with neutral drainage for 3 postoperative hours is a recommendable method because it can be helpful in reducing total blood loss in bilateral TKA.

Treatment for Concurrent Ipsilateral Femoral Neck and Shaft Fractures Using Reconstruction Nail with Temporary K-Wires

PURPOSE: The purpose of this study is to evaluate the results of operative treatment using a reconstruction nail after temporary K-wire fixation of the femoral neck for ipsilateral femoral neck and shaft fractures. MATERIALS AND METHODS: A total of 11 cases were treated, which were followed-up for more than two years, between August 2007 and July 2012. The average age was 51 years (29-69 years) and men were dominant counting eight cases. All cases were operated with a reconstruction nail after temporary K-wire fixation of the femoral neck. Bone union periods, alignment, etc. were evaluated by radiological methods and accompanying damage and complications were also investigated. Functional evaluation was performed in accordance with Friedman and Wyman criteria at the last follow-up. RESULTS: The average time for union of the femoral shaft was 22.5 weeks (12-32 weeks), and femoral neck was 13.1 weeks (8-20 weeks). There was no nonunion, and four femoral shaft fractures resulted in delayed union. There was one case of leg length discrepancy more than 2 cm long, but malalignment of more than 10 degrees was not observed. Avascular necrosis of the femoral head did not occur. Functional results were good in eight cases, fair in two cases, and poor in one case. CONCLUSION: Treatment with reconstruction nailing after temporary K-wire fixation of the femoral neck is thought to be a good method which prevents neck displacement and has low complication rates.

Popliteal Artery Pseudoaneurysm after Anterior Cruciate Ligament Re-Revision Using a Rigidfix Cross Pin

Popliteal artery injury is a very rare complication of anterior cruciate ligament (ACL) reconstruction. The authors experienced a case of popliteal arterial pseudoaneurysm after re-revision of ACL reconstruction using Rigidfix for femoral tunnel fixation. Pseudoaneurysm was detected in knee magnetic resonance imaging, which caused pain, limit of motion, common peroneal nerve palsy, leg swelling and symptoms similar to compartment syndrome. After excision and re-anastomosis of the popliteal artery using a greater saphenous vein graft, all symptoms were resolved within 3 months except for common peroneal nerve palsy. So we report on this case with a review of the literature.

Acute Simultaneous Ruptures of the Anterior Cruciate Ligament and Patellar Tendon

Acute simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare injury. We present a case report of a 32-year-old male patient with ruptured ACL and ipsilateral patellar tendon rupture sustained while playing baseball. Surgery was performed on the patellar tendon and the ACL simultaneously. The clinical and radiological outcomes of the treatment were successful. We present this case with a review of the literatures.

Results of Intramedullary Nailing of Femoral Shaft Fracture: Trochanteric Entry Portal (Sirus Nail) versus Piriformis Entry Portal (M/DN Nail)

PURPOSE: To compare treatment results obtained using the trochanteric (Sirus nail) entry portal with those obtained using the Piriformis fossa (M/DN) entry portal during intramedullary (IM) nailing of femur shaft fractures. MATERIALS AND METHODS: Four hundreds and thirty-two patients treated for femur shaft fracture using IM nails from February, 2001 to May, 2010 were divided into two groups. group 1 was composed of 180 patients treated through the trochanteric (Sirus nail; n=180) entry portal, while group 2 contained 170 patients treated through the piriformis fossa (M/DN nail; n=170) entry portal. We compared the clinical and radiographic findings of both groups to evaluate the treatment results. RESULTS: Functional result, range of motion and union time (18, 20 weeks) were similar in both groups. The operation time of patients in the over-weighted group was 90 minutes in group 1 and 120 minutes in group 2 (p0.05). There were 18 iatrogenic fractures in group 1 and 4 in group 2 (p<0.05). CONCLUSION: There was not much difference in complications based on clinical and radiographic findings of both groups. For groups using the trochanteric entry portal, the operation time was shorter and blood loss was lower than in groups using the piriformis entry portal. Iatrogenic fracture occurred more often in the group using the trochanteric entry portal than in the group using the piriformis entry portal.

Iatrogenic Femur Proximal Shaft Fracture during Nailing Using Lateral Entry Portal on Femur Shaft Fracture / 대한정형외과학회잡지

PURPOSE: We attempted to determine the cause of iatrogenic fractures and to prevent their occurrence during nailing using lateral entry portal on femur shaft fracture. MATERIALS AND METHODS: We conducted a retrospective study of 160 patients who had been treated with nailing using a lateral entry portal for femur shaft fractures. We compared 18 patients (group 1) with iatrogenic fractures on the femur proximal portion with 18 patients (group 2) who had no fracture, and then surveyed and analyzed the characters of the fracture, position of the portal, nail size, and complications. RESULTS: In distribution of primary femur shaft fractures, there were eight cases of proximal portion, nine cases of mid-portion, and one case of distal portion. In that of iatrogenic fractures, there were nine cases of medial fractures, five cases of lateral fractures, four cases of anterior fractures. In the entry portal of group 1, mean 1.82 mm leaned to the lateral side in antero-posteriorview, mean 5 mm leaned to the anterior side in lateral view. Anterior leaning of the entry portal was statistically significant with iatrogenic fracture. CONCLUSION: The more the entry portal leaned to the lateral and anterior side, the greater the frequency of occurrence of iatrogenic fractures. To prevent iatrognic fracture, through preoperative X-ray, we must have a precise understanding and measure anatomical bowing and variance of the femur, and must pay attention to operative procedures during the operation.

Comparison between Autogenous Bone Graft and Allogenous Cancellous Bone Graft in Medial Open Wedge High Tibial Osteotomy with 2-Year Follow-up

PURPOSE: To compare the radiographic and clinical results of medial open wedge high tibial osteotomy (OWHTO) using autogenous bone graft and allogenous cancellous bone graft for medial compartment osteoarthritis of the knee with two-year follow-up. MATERIALS AND METHODS: Fifty-one patients (52 knees) who underwent medial OWHTO from October 2007 to April. 2010 were included in the study. The patients were divided into group I (n=29) that received an autogenous tricortical bone graft and group II (n=23) that received an allogenous cancellous bone chip graft. The radiographic parameters (preoperative anatomical and mechanical femorotibial angles, modified tibial bone varus angle, and posterior tibial slope), clinical parameters, bone union period, and complications were evaluated from medical records. RESULTS: The radiographic and clinical outcomes did not show significant difference between two groups. The average bone union period was 11.7 weeks in group I and 12.1 weeks in group II. The visual analog scale score on the first postoperative day was significantly higher in group I than group II. CONCLUSIONS: Medial OWHTO using allogenous cancellous bone graft for medial compartment osteoarthritis of the knee can be considered as an alternative treatment method that provides equivalent radiographic and clinical results of OWHTO using autogenous bone graft and causes less immediate postoperative pain.

Arthroscopic Assisted Intra-Articular Reduction and Internal Fixation of Tibia Plateau Fracture

PURPOSE: We evaluated the results of arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window along with any additional bone grafts. MATERIALS AND METHODS: From March 2006 to March 2009, twelve patients with arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures over 5 mm in depression and displacement on the articular surface in computed tomography (CT) were enrolled in this study. We reduced or removed the depressed fracture fragment using freer without making a cortical window. Then, we accomplished internal fixation by a cannulated screw. All cases have not received bone graft. Both the postoperative clinical and radiological results were evaluated by the Rasmussen system. RESULTS: The fractures were healed completely in an average of 9 (range from 7 to 12) weeks. According to Rasmussen classification, we obtained satisfactory clinical results as excellent in 8 cases, good in 3 cases, and fair in 1 case; and radiological results were excellent in 7 cases and good in 5 cases. CONCLUSION: We consider that arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window and any additional bone grafts is are a useful methods for attaining satisfactory results.

Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Femur Fracture

PURPOSE: To analyze the clinical and radiologic results of minimally invasive plate osteosynthesis (MIPO) for distal femur fractures using a locking compression plate (LCP) and to evaluate its usefulness. MATERIALS AND METHODS: From May 2006 to April 2011, 23 patients (24 cases) with distal femur fracture were treated by MIPO with a LCP and followed-up for at least 12 months. Mean age was 61.6 years (35-80 years). Union time and post-operative alignment were measured on radiograph, and clinical function was evaluated by range of motion (ROM), Knee Society Score and complications. RESULTS: In 22 patients (23 cases) except for 1 case, bony union was obtained after an average of 18 weeks (12-26 weeks). The mean ROM was 124 degrees (80-135 degrees). According to the Knee Society Score, there were 12 excellent, 8 good, 1 fair and 2 poor results and the mean score was 87.5 (60-98). Postoperative complications were nonunion in 1 case, ankylosis in 1 case, malunion in 2 cases and superficial wound infection in 2 cases. CONCLUSION: The treatment of distal femoral fracture with MIPO using a LCP was considered a useful method which can result in satisfactory clinical and radiologic outcomes if there is accurate understanding about the surgical techniques and appropriate procedures involved.

The Treatment of Subtrochanteric Fractures with Proximal Femoral Nail Antirotation

PURPOSE: The purpose of this study was to analyze the results of treating subtrochanteric femoral fractures with proximal femoral nail antirotation (PFNA). MATERIALS AND METHODS: Twenty five consecutive patients diagnosed with subtrochanteric femoral fractures underwent intramedullary fixation using PFNA and followed-up for over 12 months. According to the Seinsheimer's classification, there were 2 type IIA, 9 type IIB, 2 type IIIA, 3 type IV and 9 type V. According to the AO classification, there were 10 type A, 9 type B and 6 type C. There were 16 cases of closed reduction group and 9 cases of limited open reduction group. Retrospectively, radiological outcomes were assessed at the union period, change of neck shaft angle, tip-apex distance, Cleveland index, sliding of lag screw and complication. RESULTS: Union was achieved in 23 of 25 cases, over an average of 17 weeks. Limb length shortening below 2 cm occurred in 7 patients. The Cleveland index was shown in 80% of 5, 6, 8 and 9 zone; the tip apex distance was 19.6 mm; the mean sliding distance was 4.4 mm; and the mean change of femur neck and shaft angle was varus 3 degree at the final follow-up. Complications included 3 cases of delayed union and 2 cases of nonunion. CONCLUSION: With its early bony union, ambulation, rehabilitation and low complication, PFNA is a useful and reliable choice for the treatment of subtrochanteric fractures of the femur. Limited open reduction and additional fixation such as cable grip are recommended if it is difficult to obtain anatomical reduction by closed reduction.

Comparative Analysis of Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Intramedullary Nailing in Distal Tibial Metaphyseal Fractures

PURPOSE: To compare results between minimally invasive plate osteosynthesis using a periarticular plate and intramedullary nailing in distal tibial metaphyseal fractures in two treatment groups. MATERIALS AND METHODS: Sixty-one cases of distal tibial metaphyseal fractures from December 2008 to December 2009 were evaluated. The minimal follow-up period was 12 months. Thirty patients treated by minimally invasive plate osteosynthesis using a periarticular plate were Group A; 31 patients treated by intramedullary nailing were Group B. We compared and analyzed the results of each group by radiological and clinical assessments. RESULTS: The mean bony union time was 16.4 weeks in Group A and 17.2 weeks in Group B. The mean operation time was 45 minutes in Group A and 48 minutes in Group B. The mean radiation exposure times were 4.2 minutes and 4.8 minutes, respectively. VAS scores were 0.7 points and 0.5 points in each respective group. In Group A, the VAS score was 1.7 points when we applied pressure on the skin around the plate. The mean Olerud and Molander Ankle Score was 87.4 points and 86.3 points, respectively. A superficial wound infection occurred in 1 case in each group, and angular deformities more than 5 degrees occurred in 2 Group B cases. CONCLUSION: No significant differences in results were observed between the two groups. However, a higher incidence of angular deformity was seen in the intramedullary nailing group. Therefore, we must be careful during surgery.

The Relationship between Stud Morphology and 5th Metatarsal Proximal Stress Fractures on Soccer Players / 대한스포츠의학회지

This research sets out to define the relationship between stud morphology of soccer shoes and 5th metatarsal proximal stress fractures on soccer players by comparison and analysis. After the pre-survey of 132 soccer players in Gwangju, 107 players who seem to have a 5th metatarsal fracture were selected. We investigated the shape of the studs and asked whether they had ever had a 5th metatarsal proximal stress fracture. We also asked them some questions on factors, which cause stress fracture, such as what position they play, how long they have been playing soccer as athletes and average playing time. And we analyzed correlation between these several factors and whether they had ever had stress fracture using chi-square (x2) test and Logistic regression analysis. We concluded that soccer players who wore bar type studs shoes had a much greater possibility of stress fracture than soccer players who wore the round type. Also we learned that soccer players who play mid-fielder have a much greater possibility of stress fracture than soccer players who play other positions. And the result of logistic regression analysis of relevance between soccer shoes stud morphology and stress fracture shows a statistically significant odd ratio, 6.840. It has been suggested that the morphology of the soccer shoes stud has relevance to the occurrence of stress fracture. Therefore, according to the result of this study, soccer shoes with the round shape are more helpful in preventing 5th metatarsal proximal stress fracture than soccer shoes with the bar shape.

The Results of Two Stage Surgical Treatment of Pilon Fractures

PURPOSE: To report the good results of two-stage treatment in pilon fractures. MATERIALS AND METHODS: A retrospective study of 23 patients among 30 patients with pilon fractures from March 2006 to November 2008, who underwent two-stage treatment of pilon fractures with a minimum of 24 months follow-up. The mean follow-up period was 28 months (24~41 months). In the first stage of the operation, open reduction of the articular surface and external fixation were performed after minimal incision. As the soft tissue healed, locking compression plate fixation was performed with the Minimally invasive plate osteosynthesis. Radiographic evaluation was graded by the criteria of Burwell and Charnley, and functional assessment of the ankle was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. RESULTS: The fractures were united within 16 weeks (12~30 weeks). The radiologic results showed anatomical reduction in 18 cases and a mean AOFAS score of 81. The mean range of ankle motion was 44 degrees. There were four complications: 1 case of wound infection and 3 cases of ankle osteoarthritis. CONCLUSION: Two-stage treatment of pilon fractures is a good treatment method because it is designed to obtain early anatomical reduction, definitive stable fixation, low rates of soft tissue complication, and good range of ankle motion.

Treatment of the Trimalleolar Fracture Using Posterolateral Approach: Minimum 2-year Follow Up Results

PURPOSE: To analyze the long term follow up results of treatment with posterolateral approach and to investigate its usefulness in the patients of trimalleolar fracture with posterior fragment which is above 25% of articular involvement. MATERIALS AND METHODS: There were 34 cases of trimalleolar fracture in our hospital from May 2004 to April 2008. We investigated 20 patients who underwent operation with the posterolateral approach and over-2 years follow up cases. The mean follow up period was 34 (24~58) months. Preoperative posterior malleolar fragment involved above 25% of articular surface in all cases and displaced more than 2 mm in 11 cases. We analyzed the radiologic type of posterior malleolar fragments and evaluated the function and pain through AOFAS score and complications. RESULTS: All cases showed primary union at mean 13.1 weeks. The complications are that partial ankylosis result of soft tissue contracture is seen in 2 cases (10%) and post-traumatic arthritis is seen in 1 cases (5%) and 17 cases (85%) of all patients are showed excellent AOFAS score. CONCLUSION: The posterolateral approach is a valuable method because that it enables us to easily reduction and internal fixation of the posterior malleolus and lateral malleolus at one time and the results are satisfied for a long time follow up.

Childhood Acute Immune Thrombocytopenic Purpura in Korea: Multicenter Study of Korean Society of Pediatric Hematology/Oncology / 대한소아혈액종양학회지

PURPOSE: Childhood acute immune thrombocytopenic purpura (ITP) is a benign hematologic disease. Therapy does not affect the natural history of the illness. We evaluated the clinical and laboratory findings, treatment and prognosis of childhood acute ITP in Korea through a retrospective multicenter study. METHODS: We analyzed retrospectively the data of 1, 829 children with acute ITP through survey of 33 hospitals among 43 hospitals in Korea from Sep. 1992 to Aug. 2001. RESULTS: Male to female ratio was 1.3: 1 and the median age at the diagnosis of ITP was 2.9 (0.1 17) years. Median duration of follow up was 6 months. One hundred and forty nine cases of the total 1, 829 patients (8.1%) received no treatment. The initial median platelet count of the non-treated group was 42, 500/mm3. Among the 861 cases who were followed up over 6 months, 315 cases (36.6%) progressed into chronic ITP. Associated with this high rate of chronicity of childhood acute ITP patients in Korea, we must consider the fact that acute ITP patients with fast improvement in the first episode tend not to follow up. Considering that fact, the rate of chronicity becomes 17.2% of the 1, 829 acute ITP patients. The treated group used many kinds of treatment methods. Intravenous immunoglobulins (IVIG) with or without prednisolone (PD) (67.5%) were the most commonly used regimens. In the group treated with IVIG alone, the platelet count began to rise above 50, 000/mm3 at 2.6 days, 100, 000/mm3 at 3.7 days and 150, 000/mm3 at 4.9 days. Four hundred and twenty two cases of the 1, 686 (25.0%) cases followed up after first episode of ITP relapsed. The relapse rate was significantly higher in older patients and in girls than in younger patients and in boys (P< 0.05). The chronicity of ITP statistically increased with age (P< 0.05) and that was the only valuable factor. CONCLUSION: Despite the fact that childhood acute ITP is a pretty common disaese, there is no agreement on the best treatment method for this disease. The establishment of Korean treatment guideline of childhood acute ITP, based on an analysis of multicenters, seems to be needed.