Operative Treatment of Periprosthetic Unstable Femoral Fractures of Vancouver Type B1 and C with Variable Plates / 대한고관절학회지

PURPOSE: The purpose of this study is to evaluate the outcome after operative treatment with plate fixation in Vancouver B1 and C periprosthetic unstable femoral fractures. MATERIALS AND METHODS: We conducted a retrospective assessment of 15 patients who had under gone treatment for a periprosthetic unstable femoral fracture around primary hip arthroplasty between April 1997 and July 2010. The mean age of patients was 69 years(53 to 82 years) at the time of surgery and the mean duration of follow-up was 29.2 months (six to 110 months). According to Vancouver classification, 10 patients were type B1 and five were type C. According to the time of operation, open reduction and internal fixation was performed using four different plates. Bone graft was applied in all patients, regardless of the type of plate. The present review describes the clinical and radiographic results. RESULTS: All patients were able to ambulate without assistance of crutches or walkers. Of the 15 patients, the fracture site was united in all patients. Postoperative dislocation of the ipsilateral hip was observed in one patient; however, there was no occurrence of further complications, such as infections, nerve injuries, or loosening of the femoral stems. CONCLUSION: In Vancouver type B1 and C fractures, without any loosening of the femoral stems, open reduction with plate fixation using our operative methods provided a satisfactory result.

The Adequate Amount Irrigation After Cemented Total Knee Arthroplasty / 대한정형외과연구학회지

PURPOSE: We studied the adequate amount of pulse lavage irrigation for removal of polymethyl methacrylate (PMMA) and bone particles after cemented total knee arthroplasty. MATERIALS AND METHODS: A prospective study of 8 patients who received cemented total knee arthroplasty between March 2011 and November 2011, was done. The mean age of patients was 74.0 (range 65~84). After component implantation, the knees were lavaged with 10L of normal saline using pulsatile lavage; all fluid was collected in 1 liter using standard wall suction canisters. PMMA and bone particles within the irrigation fluids were quantitated by weight. RESULTS: The average of 413 mg/L (range, 71~999 mg/L) of particle debris was removed after cemented total knee arthroplasty with 1L of irrigation. Average of 230 mg/L (range, 51~432 mg/L), 112 mg/L (range, 32~185 mg/L), 48 mg/L (range, 21~125 mg/L), 47 mg/L (range, 10~120 mg/L), 45 mg/L (range, 5~140 mg/L), 49 mg/L (range, 0~110 mg/L), 46 mg/L (range, 0~107 mg/L), 50 mg/L (range, 5~85 mg/L), 41 mg/L (range, 3~68 mg/L) of debris was removed after the second, third ,fourth, fifth, sixth, seventh, eighth, ninth and tenth liter of pulse lavage irrigation respectively. Using analysis of variance testing, there was a statistically significant difference between the debris removed with 1L and until 4L irrigation (p=0.03). CONCLUSION: The bone debris and PMMA decreased as the amount of irrigation increased, especially most of remnants within more than 5L solution for irrigation were bone particles. 4L of irrigation through pulse lavage is appropriate for removing PMMA and bone particles after cemented total knee arthroplasty because a supplementary irrigation can cause a secondary bone loss.

The Adequate Amount Irrigation After Cemented Total Knee Arthroplasty / 대한정형외과연구학회지

PURPOSE: We studied the adequate amount of pulse lavage irrigation for removal of polymethyl methacrylate (PMMA) and bone particles after cemented total knee arthroplasty. MATERIALS AND METHODS: A prospective study of 8 patients who received cemented total knee arthroplasty between March 2011 and November 2011, was done. The mean age of patients was 74.0 (range 65~84). After component implantation, the knees were lavaged with 10L of normal saline using pulsatile lavage; all fluid was collected in 1 liter using standard wall suction canisters. PMMA and bone particles within the irrigation fluids were quantitated by weight. RESULTS: The average of 413 mg/L (range, 71~999 mg/L) of particle debris was removed after cemented total knee arthroplasty with 1L of irrigation. Average of 230 mg/L (range, 51~432 mg/L), 112 mg/L (range, 32~185 mg/L), 48 mg/L (range, 21~125 mg/L), 47 mg/L (range, 10~120 mg/L), 45 mg/L (range, 5~140 mg/L), 49 mg/L (range, 0~110 mg/L), 46 mg/L (range, 0~107 mg/L), 50 mg/L (range, 5~85 mg/L), 41 mg/L (range, 3~68 mg/L) of debris was removed after the second, third ,fourth, fifth, sixth, seventh, eighth, ninth and tenth liter of pulse lavage irrigation respectively. Using analysis of variance testing, there was a statistically significant difference between the debris removed with 1L and until 4L irrigation (p=0.03). CONCLUSION: The bone debris and PMMA decreased as the amount of irrigation increased, especially most of remnants within more than 5L solution for irrigation were bone particles. 4L of irrigation through pulse lavage is appropriate for removing PMMA and bone particles after cemented total knee arthroplasty because a supplementary irrigation can cause a secondary bone loss.

Risk Factors of Periprosthetic Fracture after Total Knee Arthroplasty

PURPOSE: To evaluate the incidence rate and risk factors for periprosthetic fracture after total knee replacement (TKR). MATERIALS AND METHODS: We carried out a retrospective case-control study of 596 patients (951 knees) who underwent TKR between 1999 and 2006 and who were followed up over 36 months. We classified patients into group I (study group) and group II (control group). We subdivided risk factors as pre-operative, intra-operative, and post-operative factors. Age, osteoporosis, revision arthroplasty, CVA, and alcohol dependence were categorized as pre-operative factors; anterior femoral notching and prosthetic types (mobile, fixed, and load-bearing) were considered intra-operative factors; and post-operative activity level was classified as a post-operative factor. We obtained information from the patients' charts, X-ray film, and telephone interviews. RESULTS: The overall incidence rate was 2.25%; 3 patients were male, and 18 were female (14.28% and 85.72%, respectively). Old age (p<0.01, odds ratio=1.14), osteoporosis (p=0.01, odds ratio=4.74), revision arthroplasty (p=0.01, odds ratio=7.46), CVA (p=0.02, odds ratio=8.55), and alcohol dependence (p=0.03, odds ratio=44.54) were statistically significant among the pre-operative factors. Among the intra-operative factors, anterior femoral notching (p<0.01, odds ratio=11.74) was significant, and continued heavy labor (p<0.01, odds ratio=8.14) was significant among the post-operative factors. CONCLUSION: We concluded that old age, osteoporosis, revision arthroplasty, comorbidity related with falling down, anterior femoral notching, and continued heavy labor were associated with periprosthetic fracture after TKR.

A Comparative Study of Three Different Bone Grafting Methods for Treatment of Scaphoid Nonunion / 대한정형외과학회잡지

PURPOSE: Bone graft is a widely accepted surgical treatment for scaphoid nonunion. The purpose of this study was to analyze and compare the clinical outcomes of the three different bone graft techniques, Matti-Russe technique, Fisk-Fernandez technique and vascularized bone grafting. MATERIALS AND METHODS: This study involved 20 cases in 20 patients of established scaphoid nonunion who were treated with three different bone graft techniques and followed up for at least 1 year. We measured preoperative and postoperative pain, Mayo Modified Wrist Score (MMWS) and range of motion of the affected and normal side. For radiological evaluation we assessed bone union, avascular necrosis, and dorsal intercalated segment instability (DISI). RESULTS: There were no significant differences among the three groups with respect to the pain, MMWS, and range of motion. The union rate and correction of DISI also made no significant difference. The time to achieve bone union, which averaged 2.6 months was significantly decreased in the vascularized bone graft group than in the other two groups. CONCLUSION: All three methods were proper surgical procedures for treatment of scaphoid nonunion because there was no statistically significant difference in clinical and radiological outcomes. Among these three methods the vascularized bone grafting had the shortest time to achieve bone union so it could result in the fast functional recovery of the patient.

Treatment of Femur Supracondylar Fracture with Locking Compression Plate

PURPOSE: To evaluate the effectiveness of locking compression plate by analyzing the clinical outcomes of open reduction and internal fixation with locking compression plate in the treatment of femur supracondylar fracture. MATERIALS AND METHODS: We reviewed 21 cases of distal femur fractures which were treated with locking compression plate in our hospital from February 2005 to March 2009 and followed up for minimal 1 year. The types of fractures were seven A1, four A2, two A3, six C2, and two C3 according to AO classification. 2 cases were open fractures. The cases were evaluated by the criteria of Schatzker-Lambert. RESULTS: The mean time to union was 14.3 weeks. One delayed union, one refracture were observed, but no nonunion and postoperative infection was observed. The outcomes were excellent in 6 cases, good in 11, fair in 3, and failure in 1 by the criteria of Schatzker-Lambert. The overall results were excellent or good in 17 cases (81.0%). CONCLUSION: In the treatment of femur supracondylar fracture, open reduction and internal fixation with locking compression plate yields good result and locking compression plate is useful choice of fixation option.

Bilateral Malunion and Distal Radioulnar Joint Dislocation after Operative Treatment of Bilateral Galeazzi Fractures in Child: A Case Report

Galeazzi fractures in child is rare and seldom necessary of operative treatment because the result of conservative treatment is good. We present the patient who was a 11-year-old male and fell onto his both hands during a hundred-meter dash. His diagnosis was bilateral Galeazzi fractures and limited open reduction and internal fixation with Kirschner pins was initial treatment at local hospital. After 4 weeks postoperatively, Kirschner pins were removed and rehabilitating exercise was started. After 4 months postoperatively, he was transferred to our hospital due to malunion with severe angular deformities and distal radioulnar joint (DRUJ) dislocation. He was treated with corrective osteotomy. Thus, as in this case, we suggest more careful treatment and observation if conservative method of Galeazzi fracture in child is chosen and consider operative method as treatment according to age and pattern of fracture.

Debridement Arthroplasty using Posteromedial Approach in Elbow Joint with Pain and Bony Limitation of Motion

PURPOSE: This study evaluated the clinical outcomes of debridement arthroplasty using the posteromedial approach in elbow joints with pain and bony limitation of motion. MATERIALS AND METHODS: This study involved 16 elbows in 16 patients with pain and bony limitation of motion, which were treated by debridement arthroplasty using the posteromedial approach from March 2005 to March 2008. The mean follow up period was 27.6 (13~52) months. The clinical outcomes were analyzed using the Visual Analogue Scale(VAS) for pain scale, the preoperative and postoperative range of motion and the Mayo Elbow Performance Scores(MEPS). RESULTS: The VAS was decreased significantly from a preoperative mean of 4.5 to a postoperative mean 1.1 (p<0.001). The average arc of motion improved significantly from 61.6 (0~90)degrees preoperatively to 109.4 (80-120)degrees postoperatively (p<0.001). The MEPS also improved significantly from 59.4 to 85.6 postoperatively (p<0.001). There were no complications, such as hematoma and elbow instability. CONCLUSION: Debridement arthroplasty using the posteromedial approach is a useful surgical procedure in the elbow joint with pain and bony limitation of motion, where all compartments can be debrided, the ulnar nerve can be manipulated easily and damage to the medial collateral ligament can be minimized.