The Clinical Results of Pressurized Cement-Augmented Richard Compression Hip Screw with Trochanteric Stabilizing Plate for Intertrochanteric Fracture Compared with Pressurized Cement-Augmented Richard Compression Hip Screw Only

PURPOSE: We analyzed the radiologic and clinical outcomes of osteosynthesis using a Richard compression hip screw (RCHS) alone or RCHS with a trochanteric stabilizing plate (TSP) in patients with an intertrochanteric fracture. MATERIALS AND METHODS: From January 2006 to December 2008, 23 patients (23 cases) underwent osteosynthesis using only RCHS and 24 patients (25 cases) underwent osteosynthesis using RCHS and TSP. We evaluated the classification of fractures, the amount of collapse and shortening, and the duration of fracture union. We used a Koval classification for the evaluation of clinical outcomes. RESULTS: The amount of collapse and shortening in the RCHS-only group was statistically greater than the amount in the RCHS-with-TSP group. The union duration of fracture was 5.3 months in the RCHS-only group and 6.6 months in the RCHS-with-TSP group. The clinical outcomes in the RCHS-with TSP-group were better than the RCHS-only group. We had one case of fixation failure in the RCHS-only group and none in the RCHS-with-TSP group. There were no perioperative systemic complications or death. CONCLUSION: In patients with unstable intertrochanteric fractures, we can prevent the cut out of the lag screw or screw loosening with the use of pressurized PMMA-augmented RCHS. However, we cannot prevent excessive collapse and shortening, especially in patients with severe osteoporosis, a small diameter of the femur neck, or concealed fractures. In the case of these patients, we recommend you to use RCHS with TSP for the prevention of excessive collapse and shortening.

Treatment of an Unstable Intertrochanteric Fracture of The Femur Using a PMMA Augmented Compression Hip Screw / 대한정형외과학회잡지

PURPOSE: The aim of this study was to evaluate the clinical and radiological results of a PMMA augmented compression hip screw for the management of unstable intertrochanteric fractures of the femur in senile patients. MATERIALS AND METHODS: From May 1996 to May 2002, 30 patients (mean age 74.8 years, ranging from 51 to 89) with an unstable intertrochanteric fracture of the femur, were treated with a PMMA augmented compression hip screw. The average follow-up period was 16.8 months (12 to 36). Radiologically, the degrees of osteoporosis, the neck-shaft angle after the reduction, the position of lag screw in the femoral head, the degrees of sliding of the lag screw and the shortening of the limb when union had been achieved, the extent of the insertion of the PMMA cement, and the timing of bone union were analyzed. In addition, the changes in the ambulatory capacity were evaluated by the functional class of Koval. RESULTS: Radiologically, 5 cases of a varus deformity over 10degrees and 7 cases of lag screw sliding more than 15 mm were found in the 30 cases. However, there was no cutting out of the screw in femoral head nor was there fixation failure of the plate. In addition, union was finally achieved in all cases, although there were two cases of a delayed union. Clinically, satisfactory results were obtained in most of the cases according to the functional class of Koval. CONCLUSION: For senile patients with an unstable intertrochanteric fracture of the femur, PMMA augmented compression hip screw appears to be one of the more useful methods allowing the early ambulation and reducing the number of complications by the long immobilization.

Distraction-Neural Lengthening of Rabbit Sciatic Nerve by Tissue Expansion Technique / 대한정형외과연구학회지

PURPOSE: To determine the upper limit of peripheral nerve lengthening without loss of function, the recovery time of peripheral nerve palsy due to nerve lengthening and their histological changes. MATERIALS AND METHODS: Twelve adult New Zealand rabbits weighing about 2.5 kg were assigned to the following groups. Group 1 (n=6) was subjected to slow tissue expansion with 30% of nerve lengthening while group 2 (n=6) was rapid expansion with 40% lengthening of nerve. The expanders were refilled every 2 times during the 2nd and 4th weeks making a total four times of expansion. The rabbits were assessed in terms of affected leg paralysis, neural length gain, EMG with nerve conduction velocity and histological changes. RESULTS: In group 1 (n=6), paralysis on affected leg was found in one rabbit and was recovered spontaneously on the 4th weeks after expander removal. In Group 2 (n=6), paralysis was found in four rabbits, and three of them were recovered on 4, 5 and 9 weeks after removal of the expander. EMG study showed increase in distal latency of 2.50+/- 0.20 m/sec, and decrease in nerve conduction velocity of 62.49+/- 5.30 m/sec compared to normal side with 1.89+/- 0.14 m/sec and 75.39+/- 7.82 m/sec. The mean neural length gain was 6 mm (30% of 20 mm of initial pre-experimental nerve length) in group 1 and 8 mm (40% of 20 mm) in group 2. Light microscopic examination revealed the loss of segmental myelination, decrease of myelination, and vacuolation. Electron microscopic examination showed that the normal ring shaped contour of axon was changed to convoluted shape.