Radiographic Changes in Conservatively Treated Distal Radius Fractures

PURPOSE: To evaluate the radiographic changes in distal radius fractures treated conservatively. MATERIALS AND METHODS: We reviewed 55 patients with a distal radius fracture treated by conservative treatment. Average age was 57.6 years. According to the AO classification, 17 were A2 fractures followed by C1 (13 cases), C2 (9 cases), C3 (7 cases), B1 (6 cases) and A3 (3 cases). Closed reduction and U-shaped splint were applied as initial treatment. Long arm cast followed by short arm cast were applied for intraarticular or metaphyseal comminuted fractures. Radial inclination angle, radial length and volar tilt angle in each radiograph were measured and evaluated by statistic analysis. Radiographic changes according to ages, comminution of metaphysis and fracture type were also evaluated. RESULTS: Radial inclination, radial length and volar tilt were 22.8degrees, 12.0 mm and 8.5degrees after closed reduction, 22.1degrees, 10.5 mm and 7.7degrees at casting, 20.1degrees, 8.7 mm and 4.5degrees at cast off, and 18.7degrees, 7.4 mm and 4.1degrees at last follow-up. All three values had statistical significances between casting and removal of cast (p<0.001, p<0.001, p=0.002). Radial inclination angle and radial length in the group over 60 years had statistical significances between casting and removal of cast, comparing with the group under 60 years (p=0.037, p=0.045). CONCLUSION: Loss of reduction was more prominent between 3 to 6 weeks after injury, especially in the group 60 years or older.

Radiographic Changes in Conservatively Treated Distal Radius Fractures

PURPOSE: To evaluate the radiographic changes in distal radius fractures treated conservatively. MATERIALS AND METHODS: We reviewed 55 patients with a distal radius fracture treated by conservative treatment. Average age was 57.6 years. According to the AO classification, 17 were A2 fractures followed by C1 (13 cases), C2 (9 cases), C3 (7 cases), B1 (6 cases) and A3 (3 cases). Closed reduction and U-shaped splint were applied as initial treatment. Long arm cast followed by short arm cast were applied for intraarticular or metaphyseal comminuted fractures. Radial inclination angle, radial length and volar tilt angle in each radiograph were measured and evaluated by statistic analysis. Radiographic changes according to ages, comminution of metaphysis and fracture type were also evaluated. RESULTS: Radial inclination, radial length and volar tilt were 22.8degrees, 12.0 mm and 8.5degrees after closed reduction, 22.1degrees, 10.5 mm and 7.7degrees at casting, 20.1degrees, 8.7 mm and 4.5degrees at cast off, and 18.7degrees, 7.4 mm and 4.1degrees at last follow-up. All three values had statistical significances between casting and removal of cast (p<0.001, p<0.001, p=0.002). Radial inclination angle and radial length in the group over 60 years had statistical significances between casting and removal of cast, comparing with the group under 60 years (p=0.037, p=0.045). CONCLUSION: Loss of reduction was more prominent between 3 to 6 weeks after injury, especially in the group 60 years or older.

Cemented Total Hip Replacement Arthroplasty

The use of cement in total hip replacement arthroplasty has long controversial. However, since the 1980s, osteolysis has occurred with high frequency in cementless total hip replacement arthroplasty, and has been a significant cause for loosening. Recently, a cemented femoral stem has been frequently used because of improvements in cement techniques, materials for joint arthroplasty, design, etc. Also, the use of an acetabular cup with cement seems desirable where indications are for a revision procedure or where there is an aged patient with severe osteoporosis, and where the patient requires a broad bone graft due to an acetabular bone defect. The purpose of this article was (i) to review how to fix an acetabular cup with cement and a femoral stem in current hip replacement arthroplasty procedures and (ii) to review possible directions for further development.

Hemodynamic Analysis of Patients Who Underwent Arthroplasty without Blood Transfusion / 대한정형외과학회잡지

PURPOSE: To analyze the hemodynamic changes in patients who underwent total joint arthroplasty and received alternative treatment to blood transfusion. MATERIALS AND METHODS: Fifty-seven cases in 48 patients who received total knee and hip arthroplasty between 1998 September and 2008 February were enrolled. The mean age at the point of surgery was 70.9 years. The types of joint arthroplasty included 15 cases of total knee arthroplsty and 42 cases of total hip arthroplasy. Alternatives to blood transfusion entailed administration of 2,000 units of recombinant EPO and oral iron supplement for 1 week in patients with preoperative hemoglobin level higher than 10 g/dl, and 4,000 units of recombinant EPO with oral iron supplement or venoferrum for 1 week in patients with preoperative hemoglobin level lower than 10 g/dl. Intra-operatively, autotransfusion, plasma expander, topical hemostatic agents were used irrespective of the preoperative hemoglobin level. Postoperatively, 4,000 unit of recombinant EPO and venoferrum were administered for one week. RESULTS: Patients with mean hemoglobin level higher than 10 g/dl exhibited mean hemoglobin level of 10.7 g/dl (a mean 1.85 g/dl decrease) 7 days after the operation. Patients with mean hemoglobin level lower than 10 g/dl exhibited increased mean hemoglobin level of 9.18 g/dl (a mean 0.38 g/dl decrease) 7 days after the operation. Patients who underwent total knee arthroplasty exhibited reduction of hemoglobin from 12.8 g/dl to 10.96 g/dl (a mean decrease of 1.4 g/dl) 7 days after the operation. Patients who underwent total hip arthroplasty exhibited a change of hemoglobin from 13.4 g/dl to 11.8 g/dl (a mean decrease of 1.84 g/dl) 7 days after the operation. Patients who underwent revision arhtroplasty exhibited a change of hemoglobin from 13.8 g/dl to 12.75 g/dl (a mean decrease of 1.05 g/dl) 7days after the operation. CONCLUSION: In patients who refuse blood transfusion, there is a need to establish an adequate alternative blood management plan for surgery, such as total joint arthroplasty. We obtained good results with the hemodynamic protocol adapted for the perioperative period.