Femoral Head Size of 36 mm against Highly Cross-linked Polyethylene in Patients Younger than 60 Years: Minimun Three Years of Follow Up / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the early results of total hip arthroplasty (THA) performed using large diameter femoral head against with highly cross-linked polyethylene as a bearing surface in patients less than sixty years of age. MATERIALS AND METHODS: Seventy patients were enrolled and retrospectively reviewed. The mean age of patients at index surgery was 49 years and the mean follow-up period was 61 months. Clinical follow-up involved implementing the Harris hip score (HHS) and a radiographic evaluation that included linear radiolucency, osteolysis, and loosening. An annual wear rate was performed at 6 weeks; at 3, 6, and 12 months; and on a yearly basis thereafter. RESULTS: The average HHS at last follow-up was 94 (range: 82-98). Radiographically, no osteolysis in the pelvis or proximal femur was observed in any patient. No acetabular cup or femoral stem failed due to aseptic loosening. No eccentric wear was observed on any liner, and no liner fracture occurred. However, one patient experienced hip dislocation. The average femoral head penetration rate during the first postoperative year was 0.077+/-0.026 mm/year, and the average steady-state wear rate was 0.033+/-0.023 mm/year. CONCLUSION: THA with a large diameter femoral head of highly cross-linked polyethylene in patients younger than 60 years of age was found to produce results comparable to previous in vitro laboratory hip simulation studies. In particular, patient satisfaction was high due to no limitation in range of motion or hip posture during the early post-operative period. Longer-term follow-up is required to demonstrate the clinical benefits of this new material more comprehensively.

Subclavian Portal Approach for Isolated Subscapularis Tendon Tear: Technical Note

PURPOSE: For an isolated tear of the subscapularis tendon, the presented technique using a subclavian portal provides both a good angle for anchor placement and sufficient space for managing the upper portion of a subscapularis tendon tear. MATERIALS AND METHODS: The conventional method needs 2 additional portals for traction, debriding the footprint and anchor fixation for repair. The presented technique requires only an anterior portal for suture management and a subclavian portal without cannula for suture anchoring and placement of suture hooks. RESULTS: The two suture limbs of the anchor can be placed on the subscapularis tendon by the switching technique and these limbs are repaired sequentially. CONCLUSION: This technique is simple and reproducible and it can be applied to partial tears and minimally retracted subscapularis tears.

Anterior Dislocation of Distal Radio-Ulnar Joint: A Case Report

There are variable types in wrist joint injury. Most common case is simple distal radius fracture. And ulnar head dislocation associated with disruption of distal radioulnar ligament is unusual. Among thease injury types. volar dislocation of ulnar head in the distal radioulnar joint is not common and it is misdiagnosis frequently. So it needs to surgical operation frequently. The author reviews this injury with the relevant literature.

Outcomes after Arthroscopic Repair of Anterior Shoulder Instability after Metal Anchor to Biodegradable Anchor Fixation

PURPOSE: We compared the results of arthroscopic Bankart repair using metal and biodegradable anchor fixation. MATERIALS & METHODS: We reviewed 26 patients with anterior shoulder instability treated by arthroscopic Bankart repair from October, 2006, to March, 2007, 15 patients with metal anchors and 11 patients with biodegradable anchors. The average age was 27.4 years old (range: 17~55) and mean follow-up was 14 months (range: 12~17 months). Functional outcome was evaluated using the Korean Shoulder Score for Instability (KSSI), Rowe's Bankart Grading scale (RBGS), ASES score, and UCLA scores. RESULTS: In the metal-anchor group, the improvements of mean KSSI, ASES, UCLA score, and RBGS were 20.6, 24.0, 4.0, and 45.5, respectively. In the biodegradable anchor group, improvements of mean KSSI, ASES, UCLA score, and RBGS were 21.0, 23.6, 4.6, and 48.9. The improvements in final outcomes were not significantly different (p>.05). One metal problem and one traumatic redislocation occurred in the metal group. CONCLUSION: Both techniques produced satisfactory outcomes in the treatment of traumatic anterior instability. The biodegradable anchor group could also avoid problems with metal anchors.

Ganglion Cyst in the Patellar Tendon: A Case Report

The ganglion cyst in the knee joint is relatively rare. Also ganglion cyst in the patellar tendon is extremely rare, we found one case report in Turkey and another one case in France, but we did not found in Korea. Most ganglion cysts in knee joint have been found incidentally by arthroscopy or MRI. We diagnosed the ganglion cyst within the patellar tendon incidentally after trauma by MRI, and treated by surgery. We report a case of the ganglion cyst within patellar tendon, improved remarkably in knee joint pain especially during extension after surgery.

Conservative and Arthroscopic Treatment of Calcific Tendinitis

PURPOSE: We evaluated calcium resolution and clinical improvement of calcific tendinitis after conservative and arthroscopic treatment. MATERIALS AND METHODS: We reviewed 126 patients of calcific tendinitis treated from January,2002 to April, 2005. Average age was 53 and female dominant in 77% of the cases. Calcium deposits were involved in supraspinatus tendon in 84% of the cases. We compared clinical changes for 64 cases treated with injection, and 12 cases treated by arthroscopic decompression with 6 month follow-up. RESULTS: 77%(49/64)of the cases with steroid injection showed symptom improvement. Even though complete resolution of calcific deposit occurred in 36%(23/64), incomplete resolution in 17%(11/64) and no change in 47%(30/64), Pain was relieved in 87%(20/23), 82%(9/11) and 67%(20/30), respectively. With arthroscopic treatment, calcium deposit completely resolved in 83%(10/12), and all cases showed pain free motion after 6 months. CONCLUSION: Conservative treatment with steroid injection was effective for acute pain in resorptive phase. In cases of arthroscopic treatment, there was no need for complete removal of calcium deposit during the procedure, but clinical symptoms improved with resolution of the deposit.

Fibrous Histiocytoma in the Knee Joint : Report of 1 Case

Benign fibrous histiocytoma (also called giant cell tumor of tendon sheath) is well known but uncommon benign lesion usually occurring in hand and feet of middle age. We present a case of huge fibrous histiocytoma of the knee joint in a 41 years old woman. The patient have a sign of slight extension limitation and a swelling on the lateral side of the knee joint. The oval shape lesion was originating from the anterior joint capsule of the knee and protruding into the femoral intercondylar notch and lateral compartment. The mass was removed through mini-arthrotomy. Histologic study revealed a fibrohistiocytic tumor, composed of spindle cell, giant cell and foamy histiocyte.

Measurement of the Cement Thicknessaround the Femoral Stemin THRA: CAD Data Analysis Obtained from 3D Scanner / 대한정형외과학회잡지

PURPOSE: To measure the cement mantle thickness that developed from a rotation of the femoral stem in virtual space made by the broach. MATERIALS AND METHODS: The C stem and Versys stem of the subjects enrolled in this study were examined. A C250/400VZ(Steinbichler Co. Germany) and S/W: Geomagic & CATIA V5 was used to examine the three-dimensional configurations. The axial images were acquired after neutral placement of the femoral stem, horizontal rotation, coronal tilting, and a combination of both. The thickness was measured from the distance between the outer surface of the femoral stem and the closest vertex in the outer contour of the broach in cross-sectional images. RESULTS: The distance was <1 mm at the horizontal rotation of 3 degrees in the C stem, and at 5 degrees in the Versys stem. The distance was <1 mm at varus of 0.25 degrees in the C stem, and touched at 0.8 degrees. In the case of the Versys stem, the femoral stem touched at a varus of 1 degree. A combination of both horizontal and pivot rotation made the distance <1 mm at rotation of all angles. CONCLUSION: It might be necessary to develop a new instrument for the accurate insertion of the femoral stem along the broached space or to modify the stem design to stand against the change in the femoral stem position in the broached space.

Pain & Motion Recovery Patterns After Rotator Cuff Repair According to Tear Size / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the recovery patterns of pain and motion as well as final outcomes after rotator cuff repair according to tear size. MATERIALS AND METHODS: Sixty-one patients of rotator cuff repair (29 small to medium tear; group I, 32 large to massive tear; group II) through July 2000 to July 2003 were evaluated. Visual analogue scale (VAS) for pain, range of motion (ROM) and motion fraction (MF) between glenohumeral and scapulothoracic joint were checked serially 2, 6 and 12 months after operation. Final outcomes were accessed by ASES, SST, and UCLA score. RESULTS: Regardless of tear size, final outcomes were similar. But, recovery patterns of night pain were different from ROM and MF. In group I, night pain shown rapid initial recovery compared to more slow and gradual recovery pattern of group II. ROM and MF shown similar recovery patterns. MF recovery were gained after 12 months in group I, and 6 months in group II. CONCLUSION: After careful evaluation of recovery patterns of pain, ROM and MF according to tear size, appropriate rehabilitation protocol could be applied to assist normal functional recovery.

Recovery of Motion Fraction and Shoulder Function ofter Operative Treatment of Shoulder Instability / 대한정형외과학회잡지

PURPOSE: We expected the motion fraction could be checked, with simple radiographic examination, according to the guide-line of fluoroscopic technique, and recovery of the function also could be correlated with the improvement of the motion fraction. MATERIALS AND METHODS: We measured the motion fraction of the glenohumeral and scapulothoracic movement using fluoroscope in 30-degree intervals of arm elevation in the scapular plane. The ratio of glenohumeral to scapulothoracic movement (thetaGH/thetaST) was 1.6 for the full range of motion in scapular plane. During arm elevation, scapular tilting from the coronal plane was decreased from 42 degrees to 20 degrees tilting as well as internal rotation (scapular extension). We also measured the motion fraction (thetaGH/thetaST) and functional recovery of the shoulder in 11 patients after operative treatment of the shoulder instability in 15 patients from December 1996 to August 1997. RESULTS: We could find out a significant correlation between the recovery of motion fraction and shoulder function. These results would be applied in planing rehabilitation program after treatment of the shoulder instability. CONCLUSIONS: The measuring technique of glenohumeral to scapulothoracic movement (thetaGH/thetaST) with fluoroscopy could be applied to the simple radiographic measurement at the out-patient clinic in order to identify the pathology and recovery of shoulder motion after treatment

Cutaneous Cryptococcosis Clinically Mimicking Necrotizing Fasciitis

Secondary cutaneous cryptococcosis may occur earlier than other manifestations of disseminated cryptococcosis. A 68-year-old woman presented with multiple ulcerative lesions on the right calf of 2 weeks duration. She had been treated with antibiotics, but the lesions spread rapidly. The initial clinical impression was necrotizing fasciitis, but routine KOH mounting from the ulcerative lesions showed numerous budding yeast cells with peripheral clear zones and further investigations including a skin biopsy, tissue cultures and India ink preparations allowed a rapid and definitive diagnosis of cutaneous cryptococcosis. Studies for other evidence of infection elsewhere revealed an asymptomatic pulmonary lesion. We report a case of secondary cutaneous cryptococcosis clinically mimicking necrotizing fasciitis that occured before other manifestations of disseminated cryptococcosis.

Measurement of Posterior Laxity of Normal Knee in Korean Adults by means of KT-2000 Knee Ligament Arthrometer / 대한정형외과학회잡지

We measured normal range and mean value of the posterior laxity of normal knee which might be reference for objective and accurate diagnosis, decision of operative indication and position of knee during fixation of ligament, and role of quadriceps building in posterior cruciate ligament injury patients. These results were obtained by measurement and analysis of posterior laxity of normal knee by means of KT-2000 Knee Ligament Arthrometer. We measured 184 Korean adults (100 males, 84 females), and their average age, height, weight, and thigh circumference were 29.8 years, 165.8cm, 59.8kg, 41.2cm, respectively. At 25 degrees of knee flexion, mean posterior displacement of normal knee was 21.2mm with 15lb posterior tibial loading, 2.41mm with 20lb posterior tibial loading. And when quadriceps were tense, laxity was 0.79mm and 0.95mm at the same degree of knee flexion. At 75 degrees of knee flexion, the results were 0.57mm, 0.58mm, 0.26mm, and 0.28mm respectively. Right to left difference of posterior displacement with 20lb posterior tibial loading was 0.07mm at 25 degrees of knee flexion and 0.06mm at 75 degrees of knee flexion. We thought that above 75 degrees of knee flexion is suitable for knee position at the time of graft fixation because 75 degrees of knee flexion markedly decreased(75%) posterior displacement compare to 25 degrees of knee flexion. When quadriceps were tense, remarkable decrease of posterior laxity of normal knee was checked(58%), so we noticed quadriceps building is important to management of posterior cruciate ligament injury patients.

Change of AST & ALT in Patients with Multiple Trauma / 대한정형외과학회잡지

Increase of AST and ALT is a common biochemical finding in patients with multiple trauma. So it is difficult to make a decision for appropriate operation timing and to predict prognosis with consideration of parenchymal liver disease. We studied patients with multiple trauma who admitted to orthopedic department with increased AST & ALT and patients who had hepatitis from Jan. 1993 to Dec. 1993. The patients were checked AST & ALT on admission day and followed by the 3rd, 5th, 9th day, second and third week. We checked the relation of changed level of these enzymes and severity of injury, combined abdominal trauma, head trauma and the presence of HBs Ag/Ab. We concluded as followed: 1) Traumatized patients had high AST than ALT during first 3 days but hepatitis patients had higher ALT than AST during throughout admission days. High ALT in hepatitis patients had statistically significance compare to traumatized patients. 2) Traumatized patients with high AST were decreased more rapidly than ALT and showed normalized enzymatic level by 3rd week. 3) The AST level was higher in severely injured patients and it was statistically significant within first 3 days. But ALT was not correlated with the severity of injury. 4) In patients with abdominal injury, AST was higher than ALT and AST had significance but ALT had none. 5) There is no specific correlation between these enzyme level in neurosurgical problem and the presence of HBsAg/Ab.

CT Classification and Surgical Treatment of Intra-Articular Fractures of the Calcaneus / 대한정형외과학회잡지

Computed tomography was used in the evaluation of intra-articular fractures of the calcaneus to develop and reasonable treatment program and predict prognosis. Twenty-four fractures of the calcaneus in the twenty-two patients were shown to involve the posterior facet and classified by the images of coronal CT scan; Type 1(non-displaced), Type 2(displaced) and Type 3(comminuted). There were one Type 1, fourteen Type 2, and nine type 3 fractures, all of which were treated with open reduction, internal fixation, with or without bone graft. The length of follow-up ranged from eighteen to thirty-six months(mean, 23 months). the results were fraded by a predetermined point system. The one Type 1 had an excellent result. Of the fourteen Type 2 fractures, four had and excellent result; seven good result; two fair; and one poor. Of the nine Type 3 fractures, two had good; three fair; and four poor result. On the basis of our study, we believed that open reduction and internal fixation was a good method of treatment for the displacce or mildly comminuted intra-articular fractures of the cal-caneus.

Measurement of anterior laxity of the normal knee in Korea adults -with KT-2000 knee arthrometer / 대한정형외과학회잡지

No abstract available.

Treatment of intertrochanteric fractures of the femur: Comparison of the gamma nail and the dynamic hip screw / 대한정형외과학회잡지

No abstract available.

Treatment of ipsilateral hip and femoral shaft fractures: report of 6 cases / 대한정형외과학회잡지

No abstract available.

Treatment of the Acromioclavicular Dislocation with the Modified Weaver and Dunn Procedure / 대한정형외과학회잡지

We treated 27 cases of the complete dislocation of the acromioclavicular joint with the modified Weaver and Dunn procedure described by Shoji et al, which is resection of the lateral end of the clavicle and bone block transfer of the coracoacromial ligament, from July 1987 to December 1989. Twenty-one patients were followed for an average of fourteen months and the brief summary of the observations are as follows: 1. The peak incidence was in 3rd and 4th decades and much more prevalent in male (76%). 2. The most common cause of the injury was traffic accident and followed by fall down. 3. In functional evaluation by the Weitzmann criteria, an excellent result was seen in fourteen cases; a good result, in five; a fair result, in two. 4. The comparision of the coracoclavicular interval ratio before surgery with that after surgery facilitated the evaluation of the effectiveness of the coracoclavicular ligament reconstruction. 5. There were no major complications that could affect to end result.

Separation of the Symphysis Pubis: Report of 5 Cases / 대한정형외과학회잡지

The symphysis pubis is a nonsynovial amphiarthrosis in which the bodies of the two pubic bones are united by a fibrocartilaginous disk. This forms subsidiary tie arches that augment femorsacral arch in the erect position, ischiosacral arch in the sitting position. In normal state the symphysis is strong enough not to be separated. We experienced 5 cases of separated symphysis pubis developed during labor at the Catholic Hospital from January 1987 to December 1988. The duration of follow-up was between 12 and 19 months without any residual symptom after conservative treatment.

The Inyo Nailing for the Lateral Malleolus Fracture of the Ankle / 대한정형외과학회잡지

The Inyo nail is a new intramedullary device for the treatment of the lateral malleolus. fracture of the ankle with the advantage of rigid fixation. The authors have experieced 16 cases of the Inyo nailing for the ankle fracture and fallowed more than 1 year in the 11 of them. Two groups of patients were evaluated; Group I was treated with the Inyo nail and Group II was treated by conventional technique. The following results were obtained; 1. The Inyo nail was suitable for treatment of type A & B fractures of the ankle. 2. Group I patients resumed their preinjury ROM of the ankles and activity earlier than Group II. 3. The results in the radiographic rating and fuctional criteria were excellent in those cases of Group I than those of Group II.