Allogeneic Inlay Cortical Strut Grafts for Large Cysts or Post-curettage Cavitary Bony Defects / 대한골관절종양학회지

PURPOSE: This study was aimed to evaluate the result of inlay cortical strut bone grafts for large cysts or cavitary bone lesions in long bones. MATERIALS AND METHODS: Seven patients with large cyst or cavitary bony lesions were managed with curettage, allogeneic inlay cortical strut and cancellous bone grafts. Additional plate and screw fixations were performed in 6 patients. There were three SBCs, two FDs with secondary ABC changes, one FD and one post-cement spacer removal state. Three of them had pathologic fractures. Progression of bone healing and mechanical support and functional result were evaluated. The mean follow-up period was 25.4 months. RESULTS: Incorporations into host bones were progressed in all, average 4.2 months in six metaphyseal regions and 5.8 months in five diaphyseal regions respectively. Full structural supports were achieved in all except one patient without any additional procedures. No allograft-related complication was developed. Mean functional score according to the MSTS criteria was 29.6 at last follow up. CONCLUSION: Inlay cortical strut graft provided additional mechanical stability and bone stock for screw purchase in large cyst or cavitary defects of long bones, which allow early mobilization and excellent functional outcome.

Gene Expression in the Capsule Tissue of the Frozen Shoulder / 대한정형외과학회잡지

PURPOSE: To investigate the overall expression of extracellular matrix (ECM) and adhesion molecule genes using a gene array technique in the joint capsule of a frozen shoulder. MATERIALS AND METHODS: Tissues from 20 human shoulder joint capsules were harvested intraoperatively from patients (15 primary frozen shoulders, 5 controls) in our hospital. The RNA was isolated from the capsule tissue and the gene expression of ECM and adhesion molecules was analyzed using an oligo-array technique. RESULTS: The expression of several genes of the ECM and cell adhesion molecules was significantly higher in the capsule tissue from patients with a frozen shoulder than the controls. The gene expression of the collagen V alpha1/alpha3, VI alpha2/alpha3, VIII alpha1/alpha2, XV alpha1, XVIII alpha1 and ECM proteins including CD 44, connective tissue growth factor (CTGF), matrix metalloproteinase (MMP)-9/14, osteonectin, veriscan, hyaluronan synthase (HAS)-1, extra-cellular matrix (ECM)-1, secreted phosphoprotein (SSP)-1, tenascin C (TNC), thrombospondin 2/4 was two times higher in the frozen shoulder than the control. Several cell adhesion molecules genes including catenin alpha1, seletin p, integrin alpha3, beta2, beta4, beta5 and laminin alpha4, alpha5 were also two times higher in the in the patients with a frozen shoulder than the control. CONCLUSION: The gene expression of several ECM proteins and adhesion molecules is significantly higher in patients with frozen shoulder.

K-wire Fixation Supplemented with External Fixator Versus Volar Locked Plating for Unstable Fractures of the Distal Radius

PURPOSE: To campare the outcomes between K-wire fixation with supplementary external fixator and volar locking plate in the treatment of the unstable distal radius fracture. MATERIALS AND METHODS: We reviewed 26 unstable AO type C3 distal radius fracture retrospectively, treated from January 2004 to February 2009. They were divided into two groups; group I (14 cases of open reduction and K-wire fixation supplemented with a external fixator) and group II (12 cases of volar locked plating). Each group was statistically compared in terms of surgery time, the difference of radiologic reduction, and loss of reduction, range of motion (ROM) and Mayo wrist score. RESULTS: No statistical difference was found in terms of surgery time, radiologic reduction, and loss of reduction between two treatment groups. After 1 year of surgery, the Mayo wrist score of group I was 80.5 points, and group II was 80, which shows that both groups achieved fairly good score. Although group II gained a statistically significant improvement in the ROM of the wrist except pronation at postoperative three months, no statistical difference of ROM was found between two groups at postoperative 1 year. CONCLUSION: When it comes to the treatment for an unstable intra-articular distal radius fracture, clinical and radiological outcomes are comparable between the patients treated with K-wire fixation supplemented with a external fixator and those with a volar locking plate.

The Usefulness of Computed Tomography in Distal Radius Fractures Involving Articular Surface

PURPOSE: To evaluate the usefulness of computed tomography(CT) scanning in classification and selection of treatment method for distal radius fractures involving articular surfaces. MATERIALS AND METHODS: Plain radiographs and CT scans of 42 patients with intraarticular distal radius fractures was analysed for type of fractures and surgical indication and then the results were compared. RESULTS: Fracture types were changed in 15 of 42 patients. 10 patients with AO B1, B3, C1 or C2 type fractures were reclassified as C3 type, which suggested that CT scan revealed articular comminution more accurately. According to the assesment of plain radiographs, 16 patient needed surgical treatment. However additional 17(68%) patients were necessary operation on the bases CT scan evaluation. CONCLUSIONS: Evaluation of intraarticular fractures of distal radius using CT scan was useful for fracture classification and selection of treatment methods, which provided an accurate assessment of fracture patterns and reduction status.

Total Hip Replacement Arthroplasty with the Mallory-Head System : Minimum 8-Year Follow-up Results

PURPOSE: The purpose of this study was to assess the clinical and radiographic results of total hip arthroplasty with using the double tapered Mallory-Head system. MATERIALS AND METHODS: The clinical and radiographic results of a consecutive series of 81 total hip replacements in 75 patients were reviewed at eight to twelve years (average: 9.8 years) postoperatively. The underlying diseases were avascular necrosis in 46 hips (57%), osteoarthritis in 12 hips (15%), RA in 9 hips (11%) and others. The clinical result was evaluated on the basis of the modified Harris hip score and the modified Merle d'Aubigne-Postel score. A radiographic analysis was also performed. RESULTS: The average modified Harris hip score was improved from preoperative 56 points to postoperative 92 points. The average modified Merle d'Aubigne-Postel score was 15 points at the latest follow up, and 55 hips (68%) were classified as having clinical grades of excellent or good results. One acetabular component was revised because of loosening, and one was revised because of recurrent dislocation. CONCLUSION: The clinical and radiological evaluations of the total hip replacements using the Mallory-Head system showed good results.