New Fixation Method Using Two Crossing Screws and Locking Plate for Cubitus Varus Deformity in Young Adult Elbow: Case Report

Many types of osteotomy have been proposed for the treatment of cubitus varus deformity of the elbow, and various methods for fixation of the osteotomy site have also been described. However, no method has been perfect. We treated two cases of cubitus varus elbow deformity with step-cut osteotomy using a new fixation method with two crossing screws and an anatomically designed locking plate. Active assisted elbow range of motion (ROM) exercise was permitted at postoperative 3 days, after removal of the drainage. Preoperative and postoperative humerus-elbow-wrist angles and ranges of motion of the two patients were compared. At 3 months follow-up, each patient had recovered the preoperative elbow ROM, and achieved the complete bony union of the osteotomy site and proper correction of the cubitus varus deformity. In addition, the appropriate remodeling of the lateral bony protrusion was observed. Therefore, we introduce a new fixation method for achievement of stable fixation allowing immediate postoperative elbow motion after corrective osteotomy for cubitus varus deformity in young adults.

New Fixation Method Using Two Crossing Screws and Locking Plate for Cubitus Varus Deformity in Young Adult Elbow: Case Report

Many types of osteotomy have been proposed for the treatment of cubitus varus deformity of the elbow, and various methods for fixation of the osteotomy site have also been described. However, no method has been perfect. We treated two cases of cubitus varus elbow deformity with step-cut osteotomy using a new fixation method with two crossing screws and an anatomically designed locking plate. Active assisted elbow range of motion (ROM) exercise was permitted at postoperative 3 days, after removal of the drainage. Preoperative and postoperative humerus-elbow-wrist angles and ranges of motion of the two patients were compared. At 3 months follow-up, each patient had recovered the preoperative elbow ROM, and achieved the complete bony union of the osteotomy site and proper correction of the cubitus varus deformity. In addition, the appropriate remodeling of the lateral bony protrusion was observed. Therefore, we introduce a new fixation method for achievement of stable fixation allowing immediate postoperative elbow motion after corrective osteotomy for cubitus varus deformity in young adults.

The Role of Lunate Morphology on Scapholunate Instability and Fracture Location in Patients Treated for Scaphoid Nonunion

BACKGROUND: To determine the association between lunate morphology and the scapholunate instability using radiographic images, and investigate the association between lunate morphology and scaphoid fracture location. METHODS: Between January 2003 and December 2011, we retrospectively evaluated the plain radiographs and computed tomography (CT) images of 70 patients who underwent surgical intervention for a scaphoid nonunion, in order to determine the association between lunate type (I or II) and scapholunate instability or scaphoid fracture location. We determined the scaphoid fracture location using the fragment ratio and measured the radiolunate angle and capitate-triquetrum (C-T) distance. RESULTS: A type II lunate was present in 68.6% (48 of 70 cases). Mean fragment ratio of fracture location was 50.6% in the type II lunate group and 56.2% in the type I lunate group (p = 0.032). Sixteen of the 70 patients had dorsal intercalated segmental instability (DISI) deformities. Nine of 22 cases showed DISI deformity in type I lunate and 7 of 48 cases showed DISI deformity in type II lunate (p = 0.029). However, there were no significant differences between the presence of DISI deformity and fracture location (p = 0.15). Morphologic comparisons by both plain radiography and CT indicated a mean C-T distance in the type I lunate group (22 cases) of 2.3 mm and 5.0 mm in the type II lunate group (48 cases). The C-T distances were significantly correlated with lunate morphology (p = 0.001). CONCLUSIONS: A type II lunate was associated with low incidence of DISI deformity and proximal location of fracture in patients presenting with a scaphoid nonunion.

The Role of Lunate Morphology on Scapholunate Instability and Fracture Location in Patients Treated for Scaphoid Nonunion

BACKGROUND: To determine the association between lunate morphology and the scapholunate instability using radiographic images, and investigate the association between lunate morphology and scaphoid fracture location. METHODS: Between January 2003 and December 2011, we retrospectively evaluated the plain radiographs and computed tomography (CT) images of 70 patients who underwent surgical intervention for a scaphoid nonunion, in order to determine the association between lunate type (I or II) and scapholunate instability or scaphoid fracture location. We determined the scaphoid fracture location using the fragment ratio and measured the radiolunate angle and capitate-triquetrum (C-T) distance. RESULTS: A type II lunate was present in 68.6% (48 of 70 cases). Mean fragment ratio of fracture location was 50.6% in the type II lunate group and 56.2% in the type I lunate group (p = 0.032). Sixteen of the 70 patients had dorsal intercalated segmental instability (DISI) deformities. Nine of 22 cases showed DISI deformity in type I lunate and 7 of 48 cases showed DISI deformity in type II lunate (p = 0.029). However, there were no significant differences between the presence of DISI deformity and fracture location (p = 0.15). Morphologic comparisons by both plain radiography and CT indicated a mean C-T distance in the type I lunate group (22 cases) of 2.3 mm and 5.0 mm in the type II lunate group (48 cases). The C-T distances were significantly correlated with lunate morphology (p = 0.001). CONCLUSIONS: A type II lunate was associated with low incidence of DISI deformity and proximal location of fracture in patients presenting with a scaphoid nonunion.

Biomechanical Study of the Fixation Plates For Opening Wedge High Tibial Osteotomy

PURPOSE: The purpose of this study was to compare the mechanical stability of three types of plate systems for opening wedge high tibial osteotomy. MATERIALS AND METHODS: Forty-eight fresh frozen porcine tibia specimens were assigned to three different fixation device groups: Aescular group (16 specimens) was fixed with Aescular plates; Puddu group (16 specimens) with a Puddu plate, and TomoFix group (16 specimens) with a TomoFix plate. We compared axial displacements under compression loads from 200 to 2,000 N and maximal loads at failure among 8 specimens per group. We also compared displacements under cyclic load after 100 cycles at a compressive load of 2,000 N among 8 specimens per group. RESULTS: In all three groups, displacement under compression load increased with the increase in the axial compressive load; however, no significant intergroup differences were observed in the mean values under tested loading conditions. The mean maximal loads at failure were not significantly different (6,055, 6,798, and 6,973 N in the Aescular, Puddu, and TomoFix groups, respectively; p=0.41). While the TomoFix group showed less extension and strain during the cyclic load test, the mean values showed no significant differences among groups. CONCLUSIONS: All three plate systems were found to provide fixation stability suitable for bearing axial compression and cyclic loads while walking.

Postoperative Complications and Cost-effectiveness of Simultaneous and Staged Bilateral Total Hip Arthroplasty Using a Modified Minimally Invasive Two-incision Technique / 대한고관절학회지

PURPOSE: To compare the postoperative complications and cost-effectiveness of simultaneous and staged bilateral total hip arthroplasty (THA), using a minimally invasive two-incision technique. MATERIALS AND METHODS: All 206 patients who underwent simultaneous or staged bilateral THA using a modified, minimally invasive two-incision between January 2004 and November 2009 were registered and divided into a simultaneous bilateral THA group (group A, 147 patients) and staged bilateral THA group (group B: 59 patients). Staged THA was performed on group B with interval of at least 2 months between the initial and second surgery. Clinical evaluations, amount of blood loss, need for transfusion, complications and costeffectiveness were compared. RESULTS: Perioperative morbidity rates were similar in the two groups (P=0.546) and overall complications were not significant between the groups. Average length of hospital stay was significantly shorter in group A than in group B (average 14.6 days vs. 25.3 days; P<0.001). Total medical cost was significantly higher in group B than in group A (average 9,236 US dollars vs. 11,163 US dollars). Patients in group A required more blood transfusions than those in group B (3.02 vs. 1.90 units; P=0.003), although blood loss in the two groups were similar (892 vs. 917 ml P=0.613). CONCLUSION: Comparison of intra- and postoperative complications support the conclusion that simultaneous bilateral THA compares favorably with staged THA in terms of outcomes, complications and cost-effectiveness.

Deformities of the Lower Extremities in Hereditary Multiple Exostoses / 대한정형외과학회잡지

PURPOSE: This study was done to analyze the alignment and deformity of the lower extremity in hereditary multiple exostoses patients. MATERIALS AND METHODS: We enrolled 32 patients who were diagnosed as having hereditary multiple exostoses (HME) between January 2001 and December 2007. Based on age at diagnosis, we categorized them into 4 groups, A (0-5 years: 6 patients), B (6-10 years: 7 patients), C (11-15 years: 7 patients) and D (>16 years: 12 patients). We measured mechanical axis deviation, This included femorotibial mechanical angle (a), inferolateral angle (b), femoral mechanical proximal anatomical angle (c), femoral mechanical distal anatomical angle (d), distal tibia inferolateral angle (e) and femoral neck-shaft angle (f). We analyzed for differences among the groups of different ages. RESULTS: The average femorotibial mechanical angles (a) of Groups A/B/C/D were respectively, 178.5degrees/180.3degrees/182.5degrees/183.5degrees (p<0.05). Distal tibia inferolateral angles (e) were respectively, 91.9degrees/93.5degrees/94.2degrees/102.9degrees (p<0.05). The mechanical axis deviation of groups A, B, C, and D, respectively, were 1.7 mm, 6.0 mm, 9.6 mm, and 13.4 mm (p<0.05) on the right side, and 2.9 mm, 7.6 mm, 12.2 mm, and 15.2 mm (p<0.05) on the left side. CONCLUSION: Patients with HME have a tendency towards having valgus deformities of the knee and ankle joints, which tend to increase with age.