Perioperative Blood Loss in Intramedullary Hip Screw for Intertrochanteric Fracture: Analysis of Risk Factors

PURPOSE: We compared visible blood loss and calculated blood loss after intramedullary fixation in intertrochanteric fracture, and evaluated correlation between blood loss and its risk factors. MATERIALS AND METHODS: A total of 256 patients who underwent closed reduction and intramedullary fixation in femoral intertrochanteric fracture between 2004 and 2013 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including fracture pattern (according to Evans classification), gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score and use of antithrombotic agents. RESULTS: Total calculated blood loss (2,100+/-1,632 ml) differed significantly from visible blood loss (564+/-319 ml). In addition, the blood loss of unstable fracture patient was 2,496+/-1,395 ml and multivariate analysis showed a significant relationship between blood loss and fracture pattern (p<0.01). However, other factors showed no statistically significant difference. CONCLUSION: Total calculated blood loss was much greater than visible blood loss. Patients with unstable intertrochanteric fracture should be treated with care in order to reduce blood loss.

Selective Pedicle Screw Fixation with Long Fusion in the Treatment of Spinal Stenosis with Degenerative Scoliosis / 대한척추외과학회지

STUDY DESIGN: This retrospective study was designed to evaluate treatment options for spinal stenosis with degenerative scoliosis. PURPOSE: To evaluate the clinical outcomes based on the degree of spinal deformity for selective pedicle screw fixation with a long fusion for spinal stenosis with degenerative scoliosis. MATERIALS AND METHODS: We reviewed 54 cases performed from March 1996 to March 2006, and divided them into three groups based on osteophyte formation, pedicular rotation, and lateral transition. The three groups were analyzed for degree of correction of scoliotic and lordotic angle and bone fusion rate, as well as radiographically and clinically using the Kirkaldy-Willis questionnaire. RESULTS: Mild or moderate deformities (49 cases) were improved an average of 3 degrees of scoliotic angle, grade 1 of pedicular rotation, and 1 mm of lateral transition and were satisfied clinically. Severe deformities (5 cases) improved an average of 8 degrees of scoliotic angle, grade 2 of pedicular rotation, and 3 mm of lateral transition, but were clinically unsatisfactory. There was insignificant correction of the lordotic angle in all deformities and a fusion rate of 81.5% in mild-to-moderate deformities and 40% in severe deformities. CONCLUSION: Selective pedicle screw fixation with a long fusion for spinal stenosis with degenerative scoliosis is a treatment option for mild to moderate deformities.

Operative Treatment of Symptomatic Os Subfibulare / 대한족부족관절학회지

PURPOSE: To evaluate the clinical results of resection of os subfibulare and lateral ligament reattachment or modified Brostrom procedure in patients with symptomatic os subfibulare. MATERIALS AND METHODS: This is a retrospective study on fourteen patients (14 ankles) who have symptoms associated with os subfibulare. Between August 1999 and July 2004, they underwent 4 resection of os subfibulare and lateral ligament reattachment for ankle pain due to os subfibulare or 10 resection of os subfibulare and modified Brostrom procedure available for ankle instability due to os subfibulare. Follow-up period is averaged for 17.6 months (12-24 months). Clinical results were graded according to the AOFAS clinical rating system. RESULTS: Clinical results were rated as good in 4 ankles after resection of os subfibulare and lateral ligament reattachment, excellent in 5, good in 4, and fair in 1 ankle after the resection of os subfibulare and modified Brostrom procedure. In the last follow up period, 1 case of anterolateral ankle instability, 1 case of ankle pain and 1 case of inversion limitation were present postoperatively, but all symptoms were improved progressively. CONCLUSION: Resection of os subfibulare and modified Brostrom procedure is a good surgical technique for chronic ankle instability due to os subfibulare. But if just the ankle pain is present, resection of os subfibulare and lateral ligament reattachment is a sufficient procedure.

Correction of Sesamoid after Proximal Metatarsal Osteotomy and Distal Soft Tissue Procedure in Hallux Valgus / 대한족부족관절학회지

PURPOSE: A retrospective review of the radiographs of the proximal metatarsal osteotomy and distal soft tissue procedure for hallux valgus, evaluating the correction of the tibial sesamoid, was undertaken. We evaluated the correlation between the reduction of the tibial sesamoid and the clinical outcomes. MATERIALS AND METHODS: 17 patients (23 cases) with moderate to severe hallux valgus deformity underwent the proximal metatarsal osteotomy and distal soft tissue procedure. The preoperative and last follow-up radiographs were reviewed according to the tibial sesamoid grade classification recommended by the Research Committee of the American Orthopedic Foot and Ankle Society (AOFAS). We divided them into two groups according to the reduction of the tibial sesamoid. We anaylyzed the clinical outcomes in each group according to Mayo Clinic Forefoot Scoring System (FFSS). RESULTS: In all of the patients, the preoperative tibial sesamoid position were grade 2 or greater. At the last follow-up, 52% (n=12) were grade 1 or less (Group I) and 48% (n=11) were grade 2 or greater (Group II). In group I, the forefoot score was improved from preoperative mean value of 32.0 points to final follow-up value of 66.3 points. In group II, the forefoot score was improved from preoperative mean value of 31.7 points to final follow-up value of 65.9 points. There was no statistical significance between postoperative, average scores in group I and II (p>0.05). CONCLUSION: The position of the tibial sesamoid was corrected insufficiently in almost half of all cases. In view of clinical outcomes, there was no significant difference between the corrected group and the other group.

Correction of Sesamoid after Proximal Metatarsal Osteotomy and Distal Soft Tissue Procedure in Hallux Valgus / 대한족부족관절학회지

PURPOSE: A retrospective review of the radiographs of the proximal metatarsal osteotomy and distal soft tissue procedure for hallux valgus, evaluating the correction of the tibial sesamoid, was undertaken. We evaluated the correlation between the reduction of the tibial sesamoid and the clinical outcomes. MATERIALS AND METHODS: 17 patients (23 cases) with moderate to severe hallux valgus deformity underwent the proximal metatarsal osteotomy and distal soft tissue procedure. The preoperative and last follow-up radiographs were reviewed according to the tibial sesamoid grade classification recommended by the Research Committee of the American Orthopedic Foot and Ankle Society (AOFAS). We divided them into two groups according to the reduction of the tibial sesamoid. We anaylyzed the clinical outcomes in each group according to Mayo Clinic Forefoot Scoring System (FFSS). RESULTS: In all of the patients, the preoperative tibial sesamoid position were grade 2 or greater. At the last follow-up, 52% (n=12) were grade 1 or less (Group I) and 48% (n=11) were grade 2 or greater (Group II). In group I, the forefoot score was improved from preoperative mean value of 32.0 points to final follow-up value of 66.3 points. In group II, the forefoot score was improved from preoperative mean value of 31.7 points to final follow-up value of 65.9 points. There was no statistical significance between postoperative, average scores in group I and II (p>0.05). CONCLUSION: The position of the tibial sesamoid was corrected insufficiently in almost half of all cases. In view of clinical outcomes, there was no significant difference between the corrected group and the other group.

T-Plate Fixation for Fractures of Distal Radius

PURPOSE: To review the result of fractures of distal radius treated with the T-plate fixation and to recommend guideline for treatment of fracture of distal radius. MATERIALS AND METHODS: Between January 1999 and December 2002, among the patients with fractures of distal radius underwent T-plate fixation, we retrospectively reviewed 52 cases that had a minimum follow-up of 12 months. According to the Fernandez classification of distal radius fractures, 18 cases were type I, 4 cases were type II, 22 cases were type III, 2 cases were type IV and 6 cases were type V. To assess the clinical result, we used the Demerit Point System and for the radiologic result, we used the Point system by Scheck. We Compare the result of treatment in fractures of distal radius by T-plate fixation and K-wire fixation in Type I and III. RESULTS: Excellent to good results were obtained in 38 cases (73%) in clinical result and 39 cases (75%) in radiological results. Radiologic evidence of arthritis was presented 6 cases at follow-up examination. There was no evidence of statistical difference between Type I using T-plate and K-wire fixation (p>0.05). However in type III, result in the group of T-plate fixation were better than in pinning group (p<0.05). CONCLUSION: We obtained good result for type III with T-plate but only T-plate fiaxtion for type V was not satisfactory

Treatment of Bony Mallet Finger: Closed Reduction Using Extension Block K-wire

PURPOSE: To review the result of bony mallet finger treated with a closed reduction using extension block K-wire MATERIALS AND METHODS: Between January 2001 and November 2002, among the patients with bony mallet finger underwent closed reduction using extension block K-wire, we retrospectively reviewed 14 patients with 14 fractures who had a minimum follow-up of 12 months. RESULTS: There were 10 men and 4 women, with an average follow-up for all cases 15.7 months (range, 12 months~18 months). According to Crawford's evaluation criteria, we obtained 7 excellent, 5 good, 2 fair. We obtained bony union in all patients, with no remained pain. The average ROM was 67 degrees at postoperative 12 months. Postoperative complications occurred in two cases, which were nail deformity and mild osteoarthritis at the distal interphalangeal joint. There was no pin site infection. CONCLUSION: This technique is not only easier but also less invasive than other techniques for reduction of mallet finger. Also, it shows excellent result with lower complication rate. So, it seems a reliable treatment for bony mallet finger.

Repair of Cartilage Defect by Transplantation of Cultured Chondrocyte in the Rabbit: Difference related to Size of Defect / 대한정형외과연구학회지

Chondrocytes were harvested from knee joints of immature rabbits and cultured as monolayer until confluence, then split, and grown in collgen gel. The cells were transplanted into osteochondral defect of two different sizes (Group I : 16.1mm2, Group II : 7.1mm2) made on the patellar groove of distal femur in 21 mature rabbits. Left legs were used as experimental group and right leg as control. After 7 weeks, 1 out of 5 in experimental side and none out of 5 in the control side showed cartilaginous repair in Group I and 3 out of 8 in experimental side and 2 out of 8 in control side showed cartilaginous repair in Group II. After 14 weeks, 1 out of 4 in experimental side and none out of 4 in control side showed cartilaginous repair in Group I and 2 out of 4 in experimental side and 2 out of 4 in control side showed cartilaginous repair in Group II.