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.

Functional Evaluation of the r-nailing Treatment of Intertrochanteric Fracture Older than 60 years Old Patient

PURPOSE: To evaluate the functional status after Gamma nailing in inter-trochanteric fractures in elderly with functional recovery score (FRS). MATERIALS AND METHODS: We reviewed 285 patients of intertrochanteric fracture treated by gamma nailing from January 1993 to May 2002 with follow up more than 3 years. We analized recovery of functional status concerned with sex, age, fracture pattern, functional recovery index. RESULTS: The intertrochanteric fractures in elderly resulted in 15.8% loss of function after 3 years. The more functional loss was observed in female, the older age, and Boyd-Graffin type II fracture but, were not signifily related with functional loss except age. CONCLUSION: We concluded that the age is the important factor to functional recovery to pre-injury status in elderly patients.

Effects of the Peroxisome Proliferator-Activated Receptor Ligand Troglitazone in Osteosarcoma Cell Lines / 대한정형외과학회잡지

PURPOSE: We wanted to investigate the effects of Troglitazone (TRO) on the cellular growth in two human osteosarcoma cell lines (U2OS and HOS). MATERIALS AND METHODS: Cell viability was assessed by performing trypan blue exclusion assay. FACScan analysis was performed to study the cell cycle and apoptosis. Antibodies against PTEN, tAkt, pAKt, Bcl-2, Bax, pRB, p21(Cip1), and beta-actin were used in the Western blot analysis. RESULTS: TRO inhibited the growth of both the osteosarcoma cell lines. TRO induced G0/G1 arrest in the cell cycle progression for both osteosarcoma cell lines. TRO induced the apoptosis of HOS cells, but it decreased apoptosis of the U2OS cells. TRO induced Rb dephosphorylation and the increased expression of p21(Cip1). TRO increased the PTEN and Bcl-2 expressions and it decreased the level of pAkt, pRb and Bax. CONCLUSION: The present study suggested that TRO may be used as a chemotherapeutic agent for the treatment of human OS. Yet further study is required for uncovering the precise the mechanism of TRO.

Early Subluxation of Hip in Children with Cerebral Palsy

OBJECTIVE: Hip deformity is one of the common problems in children with cerebral palsy. And it is important to detect hip subluxation or dislocation as early as possible. The purpose of this study is to find the incidence of hip subluxation in early childhood in patients with cerebral palsy. METHOD: We reviewed clinical and radiological records of children with cerebral palsy under 36 months of age. We measured migration index, acetabular index, center edge angle and neck shaft angle from hip X-ray of patients. RESULTS: Total 76 patients were included in this study. The mean of migration index was 4.5+/-7.5% at 8~12 months, 10.9+/-11.9% at 13~24 months, and 18.2+/-13.0% at 25~36 months (p<0.05). Twenty one patients (27.6%) were above 25% on the migration index. The neuromotor type of cerebral palsy in 21 patients with hip subluxation, were spastic in 20 (95.2%) except one child. The incidence of hip subluxation was 25.0% (8/32) for quadriplegia, 29.6% (8/27) for diplegia and 50.0% (4/8) for hemiplegia. The acetabular index was significantly higher and the center edge angle was lower in the subluxated hip group than in the non-subluxated hip group, though no significant difference in the neck shaft angle. CONCLUSION: We concluded that the hip subluxation in cerebral palsy can occur under 36 months of age with a relatively high incidence. Therefore, it is recommended to evaluate the hip of cerebral palsy with radiological as well as clinical examination in early childhood.

The change of exercise according to time and its predicting factors in the followed - up hypertensive patients of family physicians

BACKGROUND: Hypertension is one of the common diseases which family physicians encounter to manage. Various research proved that appropriate aerobic exercise had effect on lowering blood pressure efficiently. This study was to find out the status of exercise, the change of exercise according to time and its predicting factors in hypertensive patients. METHODS: A total of 193 of the followed-up hypertensive patients of family physicians in Seoul and kyoungkido from May 11, 2001 to June 10, 2001 were interviewed by doctor according to the previously designed structured questionnaire. RESULTS: Eighty two patients (42.57) were male and mean and was 57.4 +/- 9.9 fears. Using Kaplan-Meier's method, 8% of non-exercise group (N= 115) in diagnosing hypertension started exercise after 1 fear and 40%, after 5 years. Otherwise, 5% of exercise group(N=78) stopped exercise after 1 year and 30%, after 5 years. The characteristics of 5 exercise groups according to sex, age, level of education and adequacy of exercise showed significant difference. In average blood pressure, lately started group showed the lowest (137/84 mmHg) and non-exercise group, the highest (146/91 mmHg) In the degree of recommendation. sporadic group showed the highest and non-exercise group, the lowest which showed significant difference (p =0.0024) . CONCLUSION: I conclude that lately started group among non-exercise group and continuous exercise group were mainly affected by recommendation to exercise of physician. As well as exercise, other nonpharmacologic treatment should be promoted by physician as an important strategy for treatment of hypertension.