Prevalence of rotator cuff diseases in adults older than 40 years in or near Chuncheon city, Korea

Background@#To determine the prevalence of rotator cuff diseases in a population older than 40 years in or nearby Chuncheon city, Republic of Korea. @*Methods@#Sixty shoulders of 30 people older than 40 years who participated in a health lecture were examined for free by an orthopedic surgeon. Visual analog scale of pain and American Shoulder and Elbow Surgeons scores were assigned, and routine physical examination was performed. Ultrasonography was performed on the shoulder. @*Results@#On ultrasonographic examination, there were one shoulder with full thickness rotator cuff tear, 20 of 60 (33%) with partial thickness rotator cuff tear, five of 60 (8%) with calcific tendinitis, one of 60 (2%) with tear of the long head of the biceps, and five of 50 (8%) with tendinitis of the long head of the biceps. Participants older than 60 years showed significantly high proportions of lesion of the long head of the biceps and rotator cuff diseases (P=0.019 and P=0.015, respectively). Participants who performed physical labor had high proportions of rotator cuff tear and rotator cuff disease (P=0.001 and P<0.001, respectively). @*Conclusions@#Rotator cuff diseases showed a high prevalence in elderly persons and resulted in a decrease in shoulder function.

Short-Term Results of Surgical Treatment Using TightRope™ for Acute Ankle Syndesmosis Injury / 대한족부족관절학회지

PURPOSE: The purpose of this study was to evaluate the clinical and radiologic outcome of syndesmosis fixation using TightRope™ (Arthrex, Naples, FL, USA) in acute syndesmosis injuries. MATERIALS AND METHODS: Twenty-five consecutive patients with acute syndesmosis injuries, treated using TightRope™, were reviewed. Patients were evaluated preoperatively and at the last follow-up (at least 12 months postoperatively). Clinical outcomes were assessed using American Orthopaedics Foot and Ankle Society (AOFAS) ankle-hindfoot score and self-subjective satisfaction survey. Three radiologic parameters were evaluated two times at the preoperative and final follow up from the nonweightbearing ankle anteroposterior radiographs. RESULTS: The mean AOFAS ankle-hindfoot score was 95.5 at the final follow-up. According to the satisfaction survey, 21 patients chose excellent, and four patients chose good. All radiologic parameters, including the mean tibiofibular clear space, mean tibiofibular overlap, and mean medial clear space on nonweightbearing ankle anteroposterior view, significantly improved after surgery. Complications occurred in only one patient who experienced knot irritation with infection. CONCLUSION: The short-term surgical results of syndesmosis fixation using TightRope™ were good to excellent, both clinically and radiographically. These results suggest that the fixation using TightRope™ is a valid option for acute syndesmosis injury.

Revision Total Knee Arthroplasty using Femoral Head Allograft

PURPOSE: We evaluate the results of allograft using femoral head in revision total knee arthroplasty with severe bone defects. MATERIALS AND METHODS: Between March 2000 and February 2005, the clinical records on 22 cases that had undergone the revision total knee arthroplasty using femoral head allograft were reviewed. Mean follow up period was 48(24~80) months. Allografts were used at proximal tibia in 12 cases, distal femur in 7 cases, both in 3 cases. We used posterior cruciate ligamental substituting component with extension rod in all cases. The clinical results were assessed with the knee score and functional score of Knee Society Knee Score(KSS), complication, union of allograft and so forth. We evaluated complications and union of the allograft. RESULTS: Mean degrees of preoperative and postoperative range of motion were 94+/-14 and 105+/-12 respectively. Postoperative mean knee score of KSS was increased from 45+/-10 to 79+/-8, and functional score was increased from 42+/-13 to 83+/-9. Union of allograft were observed in all cases. There were no infection, absorption and fracture of allograft. CONCLUSION: We consider allograft using femoral head in revision total knee arthroplasty with severe bone defects is one of the useful method.

Trochanteric Management for Unstable Intertrochanteric Femoral Fracture in the Elderly Patients

PURPOSE: To evaluate the results after fixation with figure of eight and cerclage wiring for comminuted trochanteric fracture. Because comminution of the femoral trochanteric fracture in elderly patients is severer in the operating field than x-ray findings, so the fixation is more difficult. MATERIALS AND METHODS: Between March 1998 and March 2004, the clinical records on twenty-eight patients more than 70 years old who underwent the bipolar hemiarthroplaty using calcar replacement type of femoral stem and followed more than 24 months were reviewed. Figure of eight and cerclage wiring was used for the comminuted trochanteric fracture of the femoral intertrochanteric fracture. The mean age was 80.4 (70~103) years. 19 cases were female, 9 cases were male. Mean follow-up period was 58 (24~92) months. We evaluated the results by modified Harris hip score, walking ability, activity of daily living, radiologic findings and union of the fracture. RESULTS: The mean duration of bony union was 12 weeks. The mean postoperative modified Harris hip score was 82.3. Preoperative walking ability was recovered in 23 cases (82%). Also basic activity of daily living was recovered in 22 cases (79%). Nonunion of trochanter was found in only one case by radiologic evaluation but clinical correlation was not significant. CONCLUSION: We consider fixation with figure of eight and cerclage wiring for unstable intertrochanteric fracture of femur in the elderly patient is more appropriate in terms of convenience of fixation, duration of union, early ambulation and cost effectiveness.

Postoperative Mortality Rate of Hip Fracture in Elderly Patients

PURPOSE: To evaluate the rate of mortality for the elderly patients after treatment of hip fractures and analyze the associated risk factors which might affect their mortality rate. MATERIALS AND METHODS: About the clinical records on 305 patients who had undergone the treatment in hip fractures, we evaluated the mortality rate of the total number of 248 patients whose age between 70 and 103 who were followed more than 12 months of period between March 1994 and March 2003. The mean age was 81.3 years. The composition of each female and male were 176 and 72 cases respectively. 99 cases were femoral neck fractures, and 149 cases were femoral intertrochanteric fractures. The operation included bipolar hemiarthroplasty and internal fixation using multiple cannulated screws, compression hip screws and Ender nails. We compared and analyzed the relating factors for the mortality rate. RESULTS: The mean postoperative mortality rate was 14.1% (35 cases). The highest mortality rate showed for the postoperative 3 months which was 57.1% (20 cases), between 4 and 6 months was 25.7% (9 cases), and 17.1% (6 cases) were presented for 7 and 12 months. The postoperative mortality rate within 1 year was affected by underlying diseases, ASA (American society of Anesthesiologists) and cemented bipolar hemiarthroplasty. but, there were no significant difference of the other factors such as the age, gender, osteoporosis and delayed operation. CONCLUSION: The variable factors which affect the mortality rate of the hip fractures in the elderly patients whose age over 70 were mostly determined by underlying diseases, ASA grade, and cemented bipolar hemiarthroplasty. Further study should be necessary for the factors influencing on the mortality rate.

Treatment of the Hip Fracture in Elderly Patients with Cerebrovascular Accident (CVA)

PURPOSE: To evaluate the results of the treatment of the hip fractures in elderly hemiplegic CVA patients with disuse osteoporosis. Hemiplegic CVA patients have much difficulties in rehabilitation such as walking, daily activity of living and so forth. MATERIALS AND METHODS: The clinical records on thirty-four CVA patients who had undergone the treatment in hip fracture and followed more than 12 months of period between March 1998 and March 2004 were retrospectively reviewed. The treatment methods were 22 cases of bipolar hemiarthroplasty, 6 cases of compression hip screw, 3 cases of ender nail, 3 cases of multiple cannulated screw. We compared the groups underwent bipolar hemiarthroplasty (Group I), internal fixation (Group II), fracture in ipsilateral (Group A), fracture in contralateral (Group B). We evaluated the results by modified Harris hip score, walker ambulation time, walking ability and activity of daily living. RESULTS: The mean postoperative modified Harris hip score was decreased in Group I (11.7 points), Group II (9.6 points), Group A (10.0 points), Group B (12.3 points). Recovery of preoperative walking ability was achieved in total 21 cases (62%) that 7 cases (58%) were observed in Group I, 14 cases (64%) in Group II, 18 cases (67%) in Group A and 3 cases (43%) in Group B. Basic activity of daily living was possible in 18 cases (53%). CONCLUSION: Hemiplegic CVA patients with hip fracture have much difficulties in rehabilitation. However, with appropriate treatment and confident positive attitude for rehabilitations of the patients, doctors and family members, we can expect more reliable results close to the pre-injury status in terms of walking ability and activity of daily living.