Relationship between Ischemia–Modified Albumin and the Healing Period of Amputation Wounds in Patients with Diabetes Mellitus Following Non-traumatic Below-Knee Amputation / 대한족부족관절학회지

Purpose@#The present study examined the effectiveness of the preoperative ischemia-modified albumin (IMA) levels in predicting the healing period of amputation wounds in patients with diabetes mellitus following a non-traumatic below-knee amputation (BKA). @*Materials and Methods@#This study enrolled 41 diabetic foot ulcer patients who underwent BKA at the authors’ hospital diabetic foot center from April 2016 to April 2022. Among the 41 patients, 29 (70.7%) were male and 12 (29.3%) were female. Their mean age was 64.54±11.38 years (41~81 years). The mean follow-up period was 19.48±5.56 weeks (14~48 weeks) after BKA. The patients were divided into two groups (high IMA group and normal IMA group), which evaluated the healing period, wound dehiscence, and revision operation rate using a Fisher's exact test and Mann–Whitney U test. Three orthopedic surgeons performed stump wound evaluation, and they were evaluated as healing when all sutures were fused without oozing. @*Results@#Thirty patients (73.2%) (group A) showed a high level of IMA (median: 91.2 U/mL), and 11 (26.8%) patients (group B) showed a normal range of IMA (median: 82.7 U/mL). In group A, the median period for wound healing took 1.4 weeks longer, which was significant (p=0.001). No statistical relationship was observed between wound dehiscence, revision operation rate, and IMA value. There was no correlation between the other risk factors (estimated glomerular filtration rate, HbA1c) and the wound healing period. @*Conclusion@#Although there was a limitation in using IMA as the sole factor to predict the healing period of amputation wounds in patients after BKA, this study revealed a significant positive correlation between IMA and the period of stump healing after BKA. Therefore, the preoperative IMA levels may help predict the period of stump healing after BKA.

Relationships between Femoral Offset Change and Clinical Score following Bipolar Hip Arthroplasty in Femoral Neck Fractures / 대한고관절학회지

Purpose@#This study aimed to investigate the relationship between femoral offset (FO) and clinical outcomes of patients with femoral neck fracture following bipolar hip arthroplasty (BHA). @*Materials and Methods@#Records for a total of 520 patients who underwent BHA for a femoral neck fracture between December 1, 2003, and September 30, 2018, were reviewed retrospectively. Patients with unclear medical records, a congenital deformity and preoperative trauma history of the hip, high-energy multiple trauma, or a history of neurodegenerative disease or cerebrovascular disease were excluded. The remaining 77 patients included in the analysis had a minimum follow-up period of one year. For clinical assessment, the postoperative pain visual analogue scale (VAS) and Harris hip score (HHS) were analyzed at each follow-up period. For radiological assessment, the difference in leg length discrepancy (LLD) and FO were measured. @*Results@#The difference in mean FO postoperatively was 6.7±4.8 mm, and the difference in mean postoperative LLD was 4.9±3.4 mm. The mean HHS was 77.1±7.7, 82.3±8.6, 83.4±7.7, and 86.4±6.7 at 1, 3, 6, and 12 months postoperative, respectively. The correlation coefficient between FO and HHS in 1-year follow-up was –0.38, and a statistically significant outcome was found (P=0.001). For the HHS domain, the correlation coefficient for function at 1-year follow-up was –0.42, revealing a statistically significant outcome (P=0.0001). @*Conclusion@#There was a statistically significant correlation between clinical outcomes and FO difference at 1 year after BHA in patients over 65 years of age with femoral neck fractures.

The Effect of Screw Apophysiodesis of Greater Trochanter in Legg-Calve-Perthes Disease / 대한정형외과학회잡지

PURPOSE: To evaluate the interstitial and appositional growth of greater trochanter post-screw apophysiodesis in Legg-Calve-Perthes (LCP) disease. MATERIALS AND METHODS: A total of 17 patients, who were diagnosed with LCP and underwent greater trochanter screw apophysiodesis and metal removal between December 2003 and December 2012, and were followed-up for at least 4 years, were selected. Anterioposterior radiologic images were taken in each process of apophysiodesis, metal removal, and last follow-up. From such images, articulotrochanter tip distance (ATD), trochanter tip-screw distance (TSD), trochanter tip-trochanter lower margin distance (TLD), and screw-trochanter lower margin distance (SLD) were measured. Appositional growth and greater trochanter growth rates were compared using paired t-test, independent t-test, and correlation analysis. RESULTS: The average ATD of the affected and unaffected sides was 14.2 and 16.8 mm, respectively at apophysiodesis and 9.2 and 14.8 mm at the last follow-up, with a significantly greater decrease observed on the affected side the unaffected side (p=0.030). TLD of the affected side during the follow-up increased 11.0 mm, from an average of 30.8 to 41.8 mm, while the un-affected side increased 14.3 mm, from an average of 26.7 to 41.0 mm. The growth of greater trochanter after the operation in the affected side was 76.7% of that in unaffected side. The ratio of TLD of the affected side to the unaffected side was significantly reduced, from 1.15 to 1.02 (p=0.014) at the final follow-up. TSD was significantly increased from 4.5 to 14.4 mm at metal removal (p < 0.001) and increased to 17.0 mm at the last follow-up. Moreover, the ratio of TSD to SLD was significantly increased from 0.20 to 0.74 at metal removal (p < 0.001) and increased to 0.84 at the final follow-up. CONCLUSION: The results of this study showed that screw apophysiodesis can suppress the overall growth, but not the appositional growth of the greater trochanter. Therefore, screw apophysiodesis may not be a good procedure to inhibit the growth of greater trochanter.

Effectiveness of Hip Arthroscopy Performed Simultaneously before Open Reduction and Internal Fixation for Acetabular Fracture and Fracture-dislocation of the Hip / 대한고관절학회지

PURPOSE: This study is performed to evaluate the usefulness of arthroscopic surgery prior to open reduction and fixation surgery to treat acetabular fractures and hip fractures-dislocation. MATERIALS AND METHODS: From January 2010 to March 2014, a total of 54 patients with acetabular fractures or hip fractures with dislocation were treated arthroscopically via fracture surface before open reduction and fixation (group 1, n=11), and without hip arthroscopy prior to open reduction and fixation (group 2; n=43). Clinical results were evaluated using Harris hip score (HHS) and visual analogue scale (VAS) pain scores. RESULTS: The mean age of patients is 43.2 years and there are 10 males and 1 females in group 1. The mean follow-up period is 15 months. The acetabular status of each case was assessed arthroscopically. Bone fragment was performed in 6 cases, and ligamentum teres shrinkage in 1 case. At the final follow up, the mean HHS and VAS pain scores were 78.6 and 2.18, respectively. During follow up, one case of osteoarthritis and one case of heterotopic ossification were identified. At the final follow up, the mean HHS and VAS pain scores were 77.5 and 2.23, respectively. In group 2, oteoarthritis and ectopic ossification were observed in 4 and 1 cases, respectively. CONCLUSION: No differences were observed in the clinical outcomes of patients with acetabular fracture or hip fracture-dislocation when treated with or without arthroscopic surgery before open reduction and fixation. However, arthroscopy is thought to be useful for evaluating the joint cartilage surface and fracture fragments more accurately.

Sequential Bilateral Rapid Destructive Inflammatory Coxarthrosis in a Patient with Human Immunodeficiency Virus / 대한고관절학회지

The diagnostic criteria for sequential rapidly destructive coxarthrosis remain unclear and this condition is rarely reported in patients with human immunodeficiency virus (HIV). Here, we report a case of an HIV-infected 73-year old female who experienced hip joint destruction. The patient was diagnosed with HIV in 2012 (at age 68 years) and began continuous treatment with nucleoside reverse transcriptase and protease inhibitors. Twenty-nine months after her HIV diagnosis, the patient experienced osteonecrosis of the right hip and underwent a total hip arthroplasty (THA). Twelve months post right-hip THA, X-ray results showed good outcomes. Eight months later (20 months post THA), however, osteolysis of the left femoral head was detected upon radiological exam and THA of the left hip was performed; chronic inflammation and fibrosis were identified in the resultant biopsy. Favorable results were obtained at 3 months after the second surgery.

Treatment of Late-Onset Legg-Calve-Perthes Disease by Arthrodiastasis

BACKGROUND: To evaluate the efficacy of arthrodiastasis for Legg-Calve-Perthes disease. METHODS: Arthrodiastasis was conducted using external fixator devices (Orthofix) in 7 patients at least 8 years of age with a diagnosis of Legg-Calve-Perthes disease. The average follow-up was 80 months (range, 32 to 149 months), and their average age was 9.1 years (range, 8 to 12 years). The results of treatment were evaluated by measuring the degree of hip pain and the range of motion of the hip at 6 months after the operation and comparing the values with preoperative measurements. Radiological recovery was evaluated by the epiphyseal index and compared with the preoperative values. At the final follow-up, clinical and radiological results were evaluated using the Iowa hip score and the Stulberg classification. RESULTS: On the clinical evaluation performed at 6 months after arthrodiastasis, the degree of pain decreased by 1.8 points on average, and the average flexion, internal rotation, and abduction increased by 35°, 16°, and 11°, respectively. Based on radiological findings, the epiphyseal index showed a remarkable increase of 6.6 on average (from 19 preoperatively to 26 postoperatively). At the final follow-up, the average Iowa hip score improved from 65 points preoperatively to 84 points. There were 1 Stulberg class I hip, 2 Stulberg class II hips, 3 Stulberg class III hips, 1 Stulberg class IV hip, and no Stulberg class V hip. CONCLUSIONS: We conclude that arthrodiastasis using an external fixator can be a relatively promising surgical procedure for the treatment of late-onset Legg-Calve-Perthes disease.

The Changes in Patient Pattern for Pediatric Supracondylar and Lateral Condylar Humeral Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the changes in patients pattern retrospectively for pediatric supracondylar and lateral condylar humeral fractures. MATERIALS AND METHODS: We retrospectively studied 335 pediatrics treated operatively for supracondylar and lateral condylar fracture from March 1993 to February 2013. The pediatrics were divided depending on the 10-year time period: those who received treatment from March 1993 to February 2003 as group I, and those who received treatment from March 2003 to February 2013 as group II. By each group, the differences in age, gender, cause, season of incidence, whether the time of incidence was a weekend, and education level of the parents were compared and analyzed. RESULTS: Fractures in group I were mainly due to slip down and fall down, but sports injury was the main cause of fractures in group II. There were 112 cases and 121 cases of supracondylar fractures, and 65 cases and 37 cases of lateral condylar fracture in groups I and II. Significant differences were found in the incidence of lateral condylar facture (p=0.009). In terms of the education level of the parents, the number with high school or under decreased significantly from group I to group II, from 71 cases to 45 cases (p=0.040). CONCLUSION: The supracondylar fracture does not show any significant difference according to the time lapse in the age and cause of incidence. However, the incidence of lateral condylar fracture shows a decreasing trend which may be related to the decrease of the incidence of slipping and falling, and the improvement in the parent's education level.

Changes in Tip-Apex Distance by Position and Film Distance Measured by Picture Archiving and Communication System (PACS) / 대한고관절학회지

PURPOSE: The tip-apex distance (TAD) is used to predict the clinical outcome of intertrochanteric fracture fixation. We aimed to measure the changes in TAD by position and film distance using Picture Archiving and Communication System (PACS). MATERIALS AND METHODS: We used a femur replica with a 10degrees femoral neck anteversion and a 130degrees neck shaft angle. Proximal femoral nail antirotation nail and a helical blade were inserted into the replica. Radiographs were taken at the neutral position and after applying 10degrees, 20degrees, 30degrees, 40degrees internal/external rotation, 10degrees abduction, and 10degrees and 40degrees adduction to the mechanical axis. Radiographs were taken at the replica-film distance of 10 cm and 20 cm under the same conditions, mimicking the differences in Focus-film distance (FFD), which reflect the patient's contour in clinical settings. A radiologist and an orthopedic surgeon measured the TAD twice using PACS. The average error was 2 mm (4.5%) and the standard error was +/-3.04. TADs in the neutral position constituted the standard values to measure the relative errors. RESULTS: TADs increased with an increase in the external rotation and abduction of the replica. TADs decreased with an increase in the internal rotation and adduction of the replica. For comparable measurements, relative errors were higher at FFDs of 20 cm compared to FFDs of 10 cm. CONCLUSION: Since the femur is internally rotated and adducted for reduction, orthopedic surgeons would assess the lag screw to be closer to the apex of femur on intraoperative radiographs. To have a correct measurement of the TAD after fixation of intertrochanteric fractures, radiographs should be taken in neutral position and measurement errors should be considered based on the patient's size.

Comparison of the Dyna Locking Trochanteric Nail, Proximal Femoral Nail Antirotation and Gamma 3 Nail in Treatment of Intertrochanteric Fracture of the Femur / 대한고관절학회지

PURPOSE: The purpose of this study is to compare and analyze the radiological and clinical results after treatment of intertrochanteric fractures of the femur by three devices including DLT, PFNA and Gamma 3 nail. MATERIALS AND METHODS: From January 2007 to January 2012, we reviewed 131 patients who suffered intertrochanteric fractures(33 cases of DLT, 59 cases of PFNA, 39 cases of Gamma 3 nail). The following were measured for all three groups; The tip apex distance (TAD), neck shaft angle and lag screw position at the head of femur, as well as the amount of blood loss and transfusion, operation time, duration of hospitalization and postoperative ICU admission, complications were also assessed. RESULTS: In comparison of the radiological results, there were no statistical differences among the three groups in TAD, neck shaft angle and the lag screw position. There was no statistical difference in clinical results. In the last follow-up, there was one case of nonunion in the PFNA group. There also was, in the last follow up, a development of varus angulation & cut-out of lag screw that occurred in 2 cases (DLT), 4 cases (PFNA), 1 cases (Gamma 3). There was no statistical difference among the three groups in the sliding length of the lag screw. CONCLUSION: Any certain group was not better than the others with regard to the radiological and clinical results among DLT, PFNA and Gamma nail groups in treating intertrochanteric fracture. To achieve favorable results, precise reduction of fracture site and surgical techniques are important.

Analysis of the Risk Factors and Clinical Outcomes of Femoral Intertrochanteric Fractures in Patients over 65 Years Old / 대한고관절학회지

PURPOSE: This study examined therelationship between the clinical outcome and risk factors of intertrochanteric femoral fractures in patients over 65 years old. MATERIALS AND METHODS: From January 2000 to March 2012, three hundred and twenty one patients older than 65 years, who underwent surgeryfor intertrochanteric femoral fractures, were evaluated. The following parameters wereanalyzed: the patient risk factors, such as age, sex, smoking, drinking history, cardiovascular disease, cerebrovascular disease and delayed days to surgery; admission day of the week; anesthetic method; operation time by perioperative care related to clinical outcome including postoperative mortality; and complications. RESULTS: An analysis of the risk factors revealedfemale patients to have a 13% higher mortality (P=0.043). Aduration of surgerylonger than 3 hours was associated with a 29.1% and 20.8% higher mortality and complication rate, respectively (P<0.001, P=0.027). Asurgical delay of four days or more after admission wasassociated with a 20.1% and 18.8% higher mortality risk and complication rate, respectively (P<0.001, P<0.001). Smoking, drinking history, underlying disease, anesthetic method, and operation time had no significant effect on the outcome. CONCLUSION: In addition to recognizing the importance of patient-related risk factors, modifying the operative factors, such as reducing surgical delays and method of anesthesia, can reduce the mortality and postoperative complications of intertrochanteric femoral fractures.

Relationship of Postoperative Recatheterization and Intraoperative Bladder Distention Volume in Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia

PURPOSE: The purpose of this study was to identify the risk factors for recatheterization after holmium laser enucleation of the prostate (HoLEP). MATERIALS AND METHODS: A total of 166 consecutive patients treated with HoLEP by a single surgeon from January 2010 to June 2011 were enrolled in this study. We collected data on preoperative and intraoperative parameters, including intraoperative bladder distention volume. The patients were divided into two groups. Group 1 included patients who voided successfully after removal of the catheter, and group 2 included patients who required recatheterization. Analysis and comparison of the perioperative parameters of both groups was performed for identification of risk factors for recatheterization. RESULTS: Recatheterization was required in 9 of 166 (5.4%) patients. No significant differences in age or preoperative parameters, including prostate-specific antigen, prostate volume, International Prostate Symptom Score, peak flow rate, postvoid residual urine, maximal bladder capacity, and Abrahams Griffiths number, were observed between the two groups. Of the intraoperative parameters, intraoperative bladder distention volume was significantly smaller in group 1 than in group 2 (700.65 mL vs. 897.78 mL, p<0.001). In the multivariate logistic regression analysis, after adjustment for other variables, intraoperative bladder distention volume was found to be a statistically significant risk factor for postoperative recatheterization (hazard ratio, 1.006; confidence interval, 1.002 to 1.010; p=0.002). CONCLUSIONS: Nine of 166 (5.4%) patients failed to void after HoLEP and required catheterization. Intraoperative bladder distention volume was found to be a statistically significant risk factor for recatheterization in this patient group.

Corelation between the Treatment Result and Causative Bacteria in Amputation of Diabetic Foot / 대한족부족관절학회지

PURPOSE: To evaluate correlation between the clinical results and causative bacteria in diabetic foot patients with lower extremity amputation. MATERIALS AND METHODS: One hundred twenty nine patients(131 feet) of diabetic foot amputations were followed for more than one year. Wound cultures were done by deep tissue or bone debris at first visit to our clinics. Retrospective analysis was performed using chart review and interview with the patients. Depending on the culture result, level of amputation, reinfection, duration of treatment, death rate, patient satisfaction and admission dates were evaluated. RESULTS: Microorganisms were confirmed in 114 cases. In the other 17 cases, there were no cultured microorganisms. In bacterial growth group, Methicillin-sensitive Staphylococcus aureus was the most common pathogen and accounted for 34 cases. As other common pathogens, there were Methicillin-resistant Staphylococcus aureus(24 cases) and mixed infection(14 cases). Mortality is no difference in each infected group. Mixed bacterial infected patients have higher reinfection, longer hospital day and duration of treatment, but there is no difference in patients satisfaction and pain at last follow up. CONCLUSION: The most common pathogen in diabetic foot patients with lower extremity amputation was Methicillin-sensitive Staphylococcus aureus, and mixed bacterial infected patients have higher reinfection rate, longer admission date and duration of treatment than other bacterial infected patients.

Comparison of Femoral Morphology and Bone Mineral Density between Femoral Neck Fractures and Trochanteric Fractures in 65+ Females / 대한고관절학회지

PURPOSE: To analyze, by radiograph, the difference in bone mineral density (BMD) and the proximal femoral morphology of females who are over 65 years old and have had either an intertrochanteric fracture or a femoral neck fracture. MATERIALS AND METHODS: One hundred twenty-five females over 65 years of age with femoral neck fractures or intertrochanteric fractures were examined for bone mineral density using computed tomography from April 2008 to March 2011. The bone mineral density was measured by dual-energy x-ray absorptiometry (DEXA). The morphology of the proximal femur was also measured by computed tomography in the unaffected hip. RESULTS: In the femoral neck fracture group, the mean BMD value was 0.563 g/cm2 in the femoral neck region and 0.753 g/cm2 in the intertrochanteric region. In the intertrochanteric fracture group, the mean BMD value was 0.457 g/cm2 in the femoral neck region and 0.656 g/cm2 in the intertrochanteric region. There are statistically significant differences between the femoral neck fracture and intertrochanteric fracture groups (P=0.029, 0.030). The mean cortical index was 0.59 in the femoral neck fracture group and 0.51 in the intertrochanteric fracture group. There are statistical differences between the femoral neck fracture and intertrochanteric fracture groups (P=0.001). CONCLUSION: The BMD of the proximal femoral neck and intertrochanteric regions of the intertrochanteric fracture group were significantly lower than that of the femoral neck fracture group. The cortical index was also significantly lower in the intertrochanteric fracture group than the femoral neck fracture group. BMD and computed tomography seem useful to check in women older than 65 who have fractures of the proximal femur.

Sciatic Nerve Compression Secondary Due to Ischial Tuberosity Osteochondroma

Ostehochondroma is a common primary benign bone tumor, and is mostly asymptomatic. Symptoms are related complications due to compression on the adjacent nerve. The sciatic nerve compression secondary to osteochondroma has rarely been reported. A 21 year-old man had right hip pain radiated to the right lower extremity. In a radiological evaluation, bone mass was detected at the right ischial tuberosity. After dynamic ultrasonography, we excised the bone mass and decompressed the sciatic nerve. The bone mass was diagnosed as osteochondroma by pathologic evaluation. We report the case with a review of the literature.

Results of the Kapandji Procedure in the AO Type C Distal Radius Fracture in Patients over Age 60

PURPOSE: To evaluate the clinical and radiologic results of the Kapandji procedure in AO classification type C distal radius fracture patients over 60 years old. MATERIALS AND METHODS: Twenty-one type C distal radius fracture patients over the age of 60 years who were treated with the Kapandji procedure from June 2004 to June 2009 in our hospital and had a post-operative follow-up period of more than 1 year were enrolled. The volar tilt, radial inclination, and radial length were measured for the radiographic analysis using the modified Lidstrom scoring system about post-operative reduction loss in every follow-up radiogram. The clinical result was assessed with a visual analogue scale (VAS) and Korean Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) score at the last follow-up. RESULTS: The mean radiologic loss of volar tilt was 1.1degrees and the mean loss of radial length was 2.6 mm and the mean radial inclination loss was 2.7degrees compared with the immediate post-operative period and last follow-up period. The average VAS and DASH scores were 1.4 and 15.9. CONCLUSION: The radiologic results of closed reduction and percutaneous pinning using the Kapandji technique for distal radius AO type C fracture patients over 60 years of age was not satisfactory. Nevertheless, the clinical results were satisfactory.

Clinical Value of Nerve Root Sedimentation Sign in Lumbar Spinal Stenosis

STUDY DESIGN: A retrospective study. OBJECTIVES: To assess the diagnostic value of the sedimentation sign seen on MRI with lumbar spinal stenosis and to compare postoperative clinical results. SUMMARY OF LITERATURE REVIEW: Nerve root sedimentation sign is an additional tool to diagnose lumbar spinal stenosis. MATERIALS AND METHODS: There were 302 patients enrolled that had been diagnosed with lumbar spinal stenosis by MRI, which were reviewed to identify a sedimentation sign and all underwent the operative treatment. There were 142 patients who could not have their spinal stenosis diagnosis confirmed by MRI, and thus were selected as the control group to estimate the diagnostic value of nerve root sedimentation sign. Correlation with the duration of preoperative symptoms and the number of involved segments were compared and analyzed between sedimentation sign positive (Group I) and negative (Group II). We estimated Million Visual Analogue Score (MVAS) and Korean Oswestry Disability Index (KODI) for the assessment of the pain and the functional disability. RESULTS: A positive sedimentation sign was found in 265 patients (87.7%) and diagnostic value was statistically significant (P<0.001). The involvement of 2 or more segments was significantly correlated with the sedimentation sign in the positive group (P<0.001). MVAS presented the improvement of 64.5+/-4.6%, KODI, 62.9+/-3.9% after surgical treatment in Group I. In Group II, each score showed improvement of 34.6+/-2.3% (MVAS), 37.1+/-1.8% (KODI). The improvement of these scores in Group I was better than in Group II. CONCLUSIONS: The nerve root sedimentation sign is an additional tool to diagnose lumbar spinal stenosis and the considerable factor to decide the operation.

Open Reduction and Internal Fixation with AO Calcaneal Plate for Displaced Intra-articular Calcaneal Fracture

PURPOSE: To evaluate the surgical outcomes of open reduction and internal fixation of AO calcaneal plate in displaced intra-articular fractures of the calcaneus. MATERIALS AND METHODS: From January 2004 to July 2007, 25 patients with 27 displaced intra-articular calcaneal fractures were treated by open reduction and internal fixation using the AO calcaneal plate. Preoperative, postoperative evaluations and a follow-up after 1 year were done radiologically by the Bohler angle, Gissane angle, heel height and width among all patients. Their functional status was assessed by means of the Maryland foot score. RESULTS: The mean Bohler angle, Gissane angle, heel height and width were restored comparing with preoperative data. However, in Sanders type IV, some losses of reduction occurred at 1 year follow-up (p<0.05). The mean Maryland foot scores were 85 points in type II, 82 points in type III and 63 points in type IV. Sanders types significantly affected the clinical results (p<0.05). CONCLUSION: The AO calcaneal plate fixation using extensile L-shpaed lateral approach shows satisfactory radiologic and clinical results in the treatment of displaced intra-articular calcaneal fractures.

Treatment Outcome of Lower Lumbar Fracture with Neurological Deficit

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the clinical results of surgical treatment for a lower lumbar fracture with a neurological deficit. SUMMARY OF LITERATURE REVIEW: There are several methods for treating lower lumbar fractures with neurological deficits but no definitive guidelines have been established. MATERIALS AND METHODS: From 2000 to 2008, this study reviewed 26 patients who had undergone surgery to treat a lower lumbar fracture with a neurological deficit and could be followed up for more than 12 months. The changes in the kyphotic angle, changes in the vertebral body height, compromise ratio of the spinal canal, recovery of neurological deficit, and clinical results were evaluated. RESULTS: There were 15, 7 and 4 cases with a third, fourth and fifth lumbar fracture, respectively. There are 19, 2 and 5 cases of an unstable bursting fracture, chance fracture and translational injury, respectively. The compromise ratio of the spinal canal improved from 67.2+/-9.4% to 16.4+/-4.6%, and the changes in the kyphotic angle improved from 14.5+/-3.2degrees to 7.6+/-2.4degrees postoperatively and 9.7+/-4.3degrees at the last follow-up. The changes in the vertebral body height improved from 41.3+/-8.4% to 23.4+/-6.3% and the bone union rate was 92.3%. The neurological deficit recovered with 1.27degrees according to the Frankel classification and good functional results were obtained in 84.6% of cases. CONCLUSIONS: Recovery of the neurological deficit and good clinical results were obtained with the recovery of the kyphotic angle and bone union with posterior decompression and instrumented posterolateral fusion in lower lumbar fractures with a neurological deficit.

Bipolar Hip Arthroplasty vs. Total Hip Arthroplasty for Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: To retrospectively compare surgical outcomes between bipolar hip arthroplasty and total hip arthroplasty in patients with osteonecrosis of the femoral head. MATERIALS AND METHODS: Between April 2000 and July 2004, we reviewed 51 cases with Ficat stage III osteonecrosis of the femoral head that underwent bipolar hip arthroplasty (BHA) and 52 cases that received total hip arthroplasty (THA). The minimum follow-up period was 5 years. All prostheses used in the current study had cementless stem and metal-on-polyethylene bearings. We analyzed clinical and radiological results, reoperation, operation time and blood loss the BHA group (mean follow-up of 81 months) and the THA group (82 months). RESULTS: There were no statistically differences between the two groups in preoperative and postoperative mean Harris hip scores. There were no significant differences between the two groups in clinical results, including persistent inguinal pain and radiologic changes around the acetabular cup and femoral stem (p>0.05). Three cases (5.9%) in the BHA group and 5 cases (7.7%) in the THA group underwent revisions. The mean operation time was 96 minutes in the BHA group and 118 minutes in the THA group. Mean blood loss was 625 cc in the BHA group, and 784 cc in the THA group. The differences between the two groups in mean operation time and blood loss were significant (p<0.05). CONCLUSION: The BHA group, which used cementless stem and metal-on-polyethylene bearings for Ficat stage III osteonecrosis of the femoral head, showed no significant differences from the THA group in postoperative radiologic change, clinical evaluation, and reoperation during 81 months of mean follow-up.

Clinical Outcome of Surgical Treatment for Intra-articular Distal Humerus Fracture

PURPOSE: To evaluate functions of the elbow joint according to surgical approach, time to exercise, and type of fracture after surgical treatment for the intra-articular comminuted fracture of the distal humerus. MATERIALS AND METHODS: 27 patients with the intra-articular comminuted fractures of the distal humerus underwent surgery from March, 2000 to January, 2007. We investigated the surgical approach, time for union, time to exercise and age. We also evaluated postoperative functions of the elbow joint according to the flexion contracture, the range of motion and the Mayo elbow performance score. RESULTS: The average follow-up period was 37 months and the average time for union was 14 weeks. The average range of flexion was 115 degrees, the average flexion contracture was 10 degrees, and the Mayo elbow performance score with average value of 85 point showed good clinical results. There were no statistically significant differences in functions of the elbow joint according to the operative method and age. However, patients with early postoperative exercise within 6 days showed statistically better outcomes than patients with postoperative exercise after 7 days. Type C1, 2 fractures showed statistically better results than the type C3 fracture. CONCLUSION: Stable fixation and early exercise are required to prevent postoperative complications and restore functions of the elbow joint with an intra-articular comminuted fracture of the distal humerus.