Management of the Diabetic Foot Ulcer in Elderly Patients Using the Anterolateral Thigh Perforator Free Flap / 대한족부족관절학회지

PURPOSE: To evaluate the results of anterolateral thigh perforator free flap for reconstruction of foot and ankle in old diabetic patients. MATERIALS AND METHODS: Fifteen diabetic foot ulcer patients over the age of 55 were operated with anterolateral thigh perforator free flap. Hematological, hemodynamic, diabetic, bacteriologic and radiologic tests were checked with examination of blood vessel state in both the donor site and the recipient site. After surgery, serial check-up was performed at 6 week, 6 month, and 1 year postoperatively on the survival of transplantation tissue, condition of foot, and condition of walking. RESULTS: There are one case of transplantation failure and four cases of partial tissue-necrosis. Delayed wound-healing was observed both recipient and donor tissue sites. At the final follow up, three cases of small ulcer were found at junction of flap and recipient tissue in plantar area. Fourteen out of fifteen patients could walk without any brace or walking aids. CONCLUSION: Reconstruction of foot and ankle region in old diabetic patients with the anterolateral thigh perforator free flap is a useful method which can prevent the amputation of foot and ankle

Reverse Hybrid Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to report the long-term clinical and radiological results of reverse hybrid total hip arthroplasty. MATERIALS AND METHODS: Between Oct. 1984 and Dec. 1987, reverse hybrid total hip replacements were performed using cemented all-polyethylene acetabular cup and porous coated tri-lock femoral stem. 26 cases in 25 patients were followed up more than 10 years. RESULTS: The average Harris hip score was 50 points preoperatively, 88 points at last follow-up. Two patients (7.7%) complained thigh pain at POD 1 years and 4 patients (15.4%) complained inguinal pain at last follow-up. On the radiologic findings, endosteal bone formation were observed with bone apposition mainly on the Gruen zone 2 and 6. Osteolysis developed in the proximal portion of the femoral stem, respectively. Definite loosening were found in 9 cases (34.6%) in the acetabulum and none in the femur. The mean rate of linear wear of polyethylene was 0.14 mm/year and the mean rate of volumetric wear was 108.75 mm3/year. CONCLUSION: The high incidence of acetabular loosening, presumably because of poor bone stock and great volumetric wear associated with use of the thirty-two-millimeter head. The result of tri-lock component can provide satisfactory clinical and radiological result.

Hydroxyapatite coated Total Hip Arthroplasty in Rheumatoid Arthritis / 대한정형외과학회잡지

Rheumatoid patients have poor bone quality and also have an increased incidence of sepsis, delayed wound healing, and general overall complications. It is the purpose of this paper to assess the clinical and roentgenographic results of ABG total hip replacement in rheumatoid arthritis. Twenty-six total hip arthroplasties done in seventeen patients with rheumatoid arthritis were studied prospectively. The average follow-up was 3 years and 4 months, with a minimum follow-up of 2 years and 7 months. The average age of the patients was 49.7 years (range 36-63) and there were sixteen females and one male. All patients fulfilled the 1987 revised criteria and there were eleven cases of protrusio acetabuli. All patients except two were taking oral steroids, nineteen cases were classed as Singhs index 1, five cases as Singhs index 2, and two cases as Singhs index 3. The Charnley approach with a trochanteric osteotomy was employed in all patients. Cup fixation was achieved with two spikes in twenty-one cases, two spikes and one screw in five cases, and in all cases the acetabular cup was angled at less than 45 from the horizontal. There was a gap between the acetabular cup and the acetabulum at DeLee and Charnley zone 1 in three cases, and at zone 2 in six cases. At 2 years, there was no radiolucency, reactive line or any sign of bone resorption. The development of cancellous and cortical densification was seen in Gruen's zone 2 and 6 for the first time in the 1 year radiographs. It became more prominent in the 2 year radiographs. The reactive bone line first became visible at the 6 month follow-up in the Gruen's zone 3 and 5. These lines extended more proximally, but it did not involve the proximal HA coated portion. Cortical hypertrophy of diaphysis was seen at Gruen's zone 3 and 5 in five cases. Rounding off of calcar was visible at zone 7 in six cases. There were no radiological changes of the femoral side in fourteen cases and the acetabular side in seven cases. There was one case of wire breakage, one case of trochanteric separation, and one case of intraoperative splitting of calcar. The result of the study indicated that the development of osseointegration in rheumatoid arthritis might be slow, but the clinical and radiological results were satisfactory. Further prospective follow up is necessary to determine whether the favorable early result of HA coated implant are maintained over longer periods.

Open Wedge Osteotomy of Sacrum in Dysplastic Spondylolisthesis: A Case Report / 대한정형외과학회잡지

Because of congenital deficiency of the superior sacral facet of S1 or the arch of L5 in dysplastic spondylolisthesis, progression of slippage may occur even in the presence of a posterior solid arthrodesis, especially in the patients with high degree of slippage and lumbosacral kyphsis. Therefore, the anterior interbody fusion may be necessary additionally. But the operation is very difficult because of a little supporting structure anteriorly for bone grafting. We have a case of dysplastic spondylolisthesis which showed progressive slippage even though solid posterolateral fusion. On which case we performed additional anterior interbody fsuion by the technique of anterior open wedge osteotomy on the superior dome of sacrum to support the L5 on S1. And this is the case report of the result.