Effects of Recombinant Human Growth Hormone Treatment in Elderly Patients Undergoing Surgery for Hip Fracture / 대한정형외과연구학회지

PURPOSE: To investigate whether early recombinant human growth hormone (hGH) treatment in elderly patients undergoing surgery for hip fracture improves biochemical and functional recovery. MATERIALS AND METHODS: From September 2007 to December 2008, a total of 25 patients older than 60 years who underwent a gamma nailing surgery for an accidental hip fracture were randomized to be treated with either hGH (Declage(R), 3mg/week) (Group I: 15 patients) or placebo (Group II: 10 patients) at a postoperative 1, 2, 3 weeks, starting within 24 hour after the hip fracture. Mean age was 73.5 years. 6 cases were male and 19 cases were female. Serum IGF-I was measured by radioimmunoassay. Subjective and objective parameters were analyzed such as the mean mid-thigh circumference, change of weight, hand grip strength, functional recovery by Modified Barthel Index of activities of daily living (ADL). RESULTS: There were significant differences in the mean serum IGF-I, mid-thigh circumference, hand grip strength, Modified Barthel Index of activities of daily living between two groups. There were no significant differences in the change of weight. There were three nausea symptom after hGH injection, but no any general adverse effect. CONCLUSION: Early recombinant human growth hormone (hGH) treatment in elderly patients undergoing surgery for hip fracture showed clinical safety and good biochemical and functional recovery.

Total Knee Arthroplasty for Salvage of Nonunion of the Distal Femur in Elderly Patients with Osteoarthritis

PURPOSE: We wanted to evaluate performing total knee arthroplasty for the salvage treatment of nonunion of the distal femoral fracture in elderly patients. MATERIALS AND METHODS: From October 2000 to March 2007, 10 patients were treated with total knee arthroplasty for salvage of nonunion of distal femoral fracture. The average age of the patients was 70.3 years (range: 60 to 75). The average follow-up period was 31.9 months (range: 12 to 90). The original fracture site was the supracondylar area in 9 cases and it was distal to the supracondylar area in 1 case. 6 patients had been treated with an anatomical plate, 3 with a Dynamic Condylar Screw and 1 with retrograde nailing. The radiograghs before knee arthroplasty demonstrated degenerative changes in the knee joint in all patients. The following total knee components were used: 7 Legacy Knee-Constrained Condylar (Zimmer) and 3 E-motion (B-Braun). The clinical assessments consisted of radiologic evaluation and the Knee Society knee Score (KSS). RESULTS: There was no malalignment >10degrees in any plane for the revision operation that was due to nonunion. The mean KSS knee score improved from 23 (range: 10~31) preoperatively to 81 (range: 68~89) postoperatively. The mean knee range of motion at the latest follow-up was 3degrees (range: 0~10degrees) to 105degrees (range: 90~130degrees). One patient required nonoperative wound care for marginal wound skin necrosis. CONCLUSION: We recommend this treatment modality for nonunion of the distal femoral fracture with coexisting gonarthrosis.

Immunohistochemical Demonstration of Nerve Fibers of the Human Knee Synovium / 대한정형외과연구학회지

PURPOSE: To demonstrate the presence of nerve fibers including nociceptive fibers in synovium of human knee joint using immunohistochemistry. MATERIALS AND METHODS: 10 Synovial membrane tissues of knee joint obtained from 5 cadavers were analyzed immunohistochemically using antibodies to protein gene product 9.5, betaIII-tubulin, substance P and calcitonin gene-related peptide (CGRP). RESULTS: Many nerve fibers immunoreactive for protein gene product 9.5 and betaIII-tubulin were demonstrated in synovial folds of human knee joints. Also, immunostaining showed the presence of free nerve ending fibers immunoreactive for substance P and calcitonin gene-related peptide in synovium. CONCLUSION: The presence of putative nerve fibers including nociceptive fibers in synovial folds supports a possible role for theses structures as source of knee joint pain.

Treatment of Upper Thoracic Disc Herniation Using Transthoracic Approach without Division of Latissimus Dorsi: Technical Note / 대한척추외과학회지

Thoracic disc herniation is a rare condition in which a posterior approach, extrapleural approach, posterolateral approach, or transthoracic approach is currently used. The posterior approach is not recommended in thoracic disc herniation surgery because of the risk of spinal cord injury. The transthoracic approach makes it possible to remove the intervertebral disc and is considered a standard method. However, due to an extensive transverse skin incision, division of the latissimus dorsi muscles, and rib resection, the conventional open approaches involve a risk of complications, such as infection and post-thoracotomy pain syndrome; and a long period of rehabilitation and recovery is required. Excision of the intervertebral disc under thoracoscopic guidance can reduce the damage to the skin and muscles, but the equipment and surgical materials are expensive and a long learning curve is required. Therefore, we report a case and a new muscle splitting transthoracic approach that can be performed by incising 10 cm of skin longitudinally and preserving the serratus anterior and latissimus dorsi muscles.

External Fixation of Pediatric Femur Fractures

PURPOSE: To evaluate unilateral external fixation when applied as the standard treatment of displaced femoral shaft fractures in children. MATERIALS AND METHODS: From 2000 through 2004, we used a unilateral external fixator (Any-fix(R)) to treat 24 femoral shaft fractures. The average age of the patients was 8.3 years (range, 5.6 to 14.8). 16 fractures were isolated, and 8 were associated with polytrauma. There were 4 open fractures. Patients were followed clinically and radiologically until healing and at 1 year. RESULTS: Average time of external fixation was 97 days (range, 57 to 130 days). All patients regained the normal range of motion of knee joint without significant residual leg length discrepancy or growth disturbance. There were no nonunion, or rotationary deformities. There were 26 pin tract infection (total pin number: 108) (24%), all of which were resolved with antibiotics. No patient developed osteomyelitis. There were two refractures after fixator removal. There was one case of reduction loss and one of valgus deformity. CONCLUSION: The external fixation is a useful alternative for operative management of femoral shaft fractures because of minimal invasive operation, and early mobilization in prepuberty.

Influence of No Smoking and Rehabilitation after Microscopic Discectomy in Lumbar Disc Herniation: A Minimum of 10-Years Follow Up / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis study of the long term clinical results of microscopic discectomy. OBJECTIVES: To evaluate clinical outcome of microscopic lumbar discectomy at the 10 year postoperative follow up SUMMARY OF LITERATURE REVIEW: There have been frequent reports of short term follow up studies for microscopic lumbar discectomies, but in there have been few long term follow-up studies reported in the literature. (Please confirm the highlighted section; before it was incomplete, so I have tried to complete for you.) MATERIALS AND METHODS: A ten year follow-up study was possible in 40 out of the 101 patients diagnosed with a lumbar disc herniation and treated with a microscopic discectomy between January 1992 and December 1993. Recurrent HIVD (Define?), followed by a microscopic discectomy, was evaluated using Kim's criteria. Also, the effects of smok0ing prohibition and rehabilitation exercise programs on recurrence were investigated. RESULTS: Among the 101 patients having undergone an operation, 5 and 10 year follow ups were performed in 83 (82.2%) and 40 cases (39.6%), respectively. Loss to follow-up was mostly due to changes of address and in the contact-list. 33 cases (84.6%) showed more than fair recovery after 5 years, with 33 cases (82.5%) showing similar results after 10 years. Postoperative smoking prohibition and exercise programs for the prevention of a recurrence were carried out on 32 cases (80%), with 2 of these cases (6.3%) showing recurrence compared with 5 cases (62.5%) in the non-control group. CONCLUSION: Postoperative smoking prohibition and rehabilitation exercise programs were useful and are recommended for lumbar disc herniation patient following a microscopic discectomy. Also, early return of the patient to their previous work could decrease the potential recurrence rate.

Dislocation of the Polyethylene Bearing of the Medial Unicompartmental Knee Arthroplasty: A Case Report

Treatment methods of unicompartmental osteoarthritis of knee joint are arthroscopy, osteotomy, unicompartmental arthroplasty, and total arthroplasty. Among them the rate of unicompartmental arthroplasty is increased and many complications are reported recently. Polyethylene wear and component loosening, and infection are the common failure mechanism, but dislocation of meniscal polyethylene is rare, and not reported. So we report the case of the dislocation of polyethylene and study the cause and preventive method.