Is Distal Locking Constantly Necessary When Intertrochanteric Femur Fracture Is Stably Fixed in the Distal Area with Intramedullary Hip Nail? / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to investigate the constant necessity of distal locking when intertrochanteric fracture was treated with an intramedullary hip nail. MATERIALS AND METHODS: From April 2010 to June 2013, 47 stable intertrochanteric fractures (AO/OTA 31-A1) were treated with second generation intramedullary hip nailing. They were followed-up for more than 12 months. In the first group of 18 cases distal locking was used, and in the second group of 29 cases, distal locking was not used. We compared the radiologic and clinical results of the two groups. RESULTS: Comparison of the two groups of patients showed no difference in terms of radiological and functional results. Postoperative thigh pain developed in eight cases (17%). A statistically difference was observed between isthmic diameter and used nail diameter (Fisher exact test, p=0.01) for postoperative thigh pain. In logistic regression analysis, the difference between isthmic diameter and used nail diameter was the most statistically significant factor in development of postoperative thigh pain (p=0.04, odd ratio=27.75). CONCLUSION: Our results suggested that the second generation intramedullary hip nail may be successfully implanted without distal interlocking in 31-A1 intertrochanteric femur fracture when the reduction status was satisfactory and stable fixation of the distal area was estimated by less than 3 mm difference between isthmic diameter and used nail diameter.

Navigated Acetabular Cup Fixation for Acetabular Deformity or Revision Total Hip Arthroplasty / 대한고관절학회지

PURPOSE: To evaluate the usefulness of navigated acetabular cup fixation for total hip arthroplasty in patients with acetabular deformity or revision total hip arthroplasty. MATERIALS AND METHODS: This study enrolled 28 patients with at least 12 months' follow-up. The safe zone of the acetabular cup was defined as 40degrees+/-10degreesin inclination and 15degrees+/-10degreesin anteversion. The authors used the navigation and radiographic data to determine whether the acetabular cup was located within the safe zone or not. To evaluate the clinical outcomes, preoperative and last follow-up Harris hip scores were checked, and the occurrence of complications was evaluated. RESULTS: According to the navigation data, the mean inclination and anteversion were 38.5degrees+/-4.7degrees(range, 32degrees-50degrees) and 16.6degrees+/-4.0degrees(range, 8degrees-23degrees), respectively. According to the radiographic data the mean inclination and anteversion were 40.5degrees+/-4.6degrees(range, 32degrees-50degrees) and 19.4degrees+/-4.2degrees(range, 8degrees-25degrees), respectively. In both cases, all values were within the safe zone. Harris hip score was improved in all patients from preoperative 52.3+/-14.4 points (range, 29-87 points) to 88.0+/-9.0 points (range, 65-99 points) at the last follow-up. There was no dislocation or loosening of both cases. CONCLUSION: Navigated acetabular cup fixation is a useful technique for total hip arthroplasty in patients with acetabular deformity or revision total hip arthroplasty because it prevents the malposition and related complications.

A Case of Congenital Nephrotic Syndrome due to Diffuse Mesangial Sclerosis

Diffuse mesangial sclerosis (DMS) is one of the underlying pathology of congenital and infantile nephrotic syndrome. Infants with DMS develop nephrotic syndrome before 2 years of age and progress to end stage renal disease within 3 years of age. The authors experienced a case of isolated DMS in a 4-month-old male infant who had nephrotic syndrome for 1 month. The diagnosis was confirmed on the basis of clinical, laboratory, pathological and molecular genetic findings. This is the 3rd case report of DMS in our country and the 1st case report of isolated DMS confirmed by molecular genetic study.