Treatment of Forearm Shaft Fracture with Modified Interlocking Intramedullary Nail

PURPOSE: To evaluate the result of forearm shaft fracture treated by modified interlocking intramedullary nail (Acumed, Hillsbrough, IN, USA). MATERIALS AND METHODS: 15 patients with fracture of radius, ulna, radio-ulna shaft treated by modified interlocking intramedullary nail from December 2003 to February 2007 were analyzed. Modified interlocking intramedullary nail has paddle blade tip and fluted rod, so the distal screw fixation was not needed but had relatively firm fixation. It has advantages including short operation time, small operation scar. The average follow up period was 8.3 months (range, 5~15 months). We analyzed the results by average union time and the functional results according to Anderson's criteria. RESULTS: The mean duration of union was 9.8 weeks in radius and 11.4 weeks in ulna. The average range of motion of forearm was 74.6 degree in supination and 72 degree in pronation.. Functional results assessed by Anderson were rated excellet in 12 cases, satisfactory in 3 cases. We found no complications such as delayed union, non-union, neurovascular injury and infection. CONCLUSION: Modified interlocking intramedullary nail (Acumed, Hillsbrough, IN, USA) is a viable therapeutic alternative in the management of forearm shaft fracture.

Percutaneous Acutrak Screw Fixation of Intra-articular Tongue Type Fracture of Calcaneus / 대한족부족관절학회지

PURPOSE: To evaluate the results of treatments by percutaneous Acutrak screw fixation for intra-articular tongue type fracture of calcaneus, especially in elderly patient or patients with underlying disease including diabetes mellitus. MATERIALS AND METHODS: Seven cases with intra-articular tongue type fracture of calcaneus, from November 2003 to February 2005, were reviewed. There were 6 males and 1 female with 65 years old mean age (range: 61~71 years old). The average follow-up period was 16 months (range: 10~25 months). Two Steinmann pins were used for closed reduction. After closed reduction was done like Essex-Lopresti's method, two Acutrak screws were inserted. The third Acutrak screw was inserted at the sustentaculum tali away from sinus tarsi to fix the primary fracture line. The patients were evaluated with Salama scale, the extent of recovery of Bohler angle, state of subtalar joint. RESULTS: Clinical results according Salama scale were excellent in 5 cases, and good in 2 cases. Average preoperative Bohler angle was 13 degrees (range: 12~15 degrees). Average postoperative Bohler angle was 31o (range: 23 degrees - 40 degrees). There were no soft tissue complications. There were two mild subtalar arthritis. CONCLUSIONS: We think that percutaneous Acutrak screw fixation is a good option for tongue type fracture of calcaneus in elderly patient or patients with underlying disease including diabetes mellitus.

Treatment of Osteoporotic Stable Burst Fracture with Percutaneous Vetebroplasty

PURPOSE: To evaluate the result of percutaneous vertebroplasty in the treatment of osteorporotic stable burst fracture that has not neurologic symptom. MATERIALS AND METHODS: A retrospective review was conducted in 37 vertebrae of 33 patinets with osteoporotic stable burst fracrure treated by percutaneous vertebroplasty from February 2000 to May 2003. Stable burst fracture was classified by McAfee. The operation was performed in the patient without neurologic symptom, BMD T-score was below -2.5 and hot uptake was seen in (99m)Tc bone scan. The operation was held from post-traumatic 7 to 32 days, average 17 days. Follow up period was from 5 months to 38 months, average 11 months. The result of the treatment was assesed by clinical finding (pain scale and work status by Denis) and radiologic findings (percentage height restored and change of kyphotic angle). RESULTS: In clinical assessment, 27 had a satisfactory pain scale below the P3, 25 had a satisfactory work status below the W3. In the radiologic findings, percentage height restore was increased from 0% to 62%, average 23.3%. The preop. kyphotic angle was from -20 degree to 42 degree, average 8.9 degree. The postop. kyphotic angle was from -20 to 42 degree, average 6.5 degree. The kyphotic angle was decreased average 2.4 degree after operation. CONCLUSION: Treatment of osteoporotic stable burst fracture with percutaneous vertebroplasty is the minimal invasive treatment that has satisfactory pain relief and reduction of fracture.

Treatment of Displaced Transverse Patellar Fractures with Cannulated Screws and Figure-Eight Wiring

PURPOSE: To evaluate the radiographic and clinical results of displaced transverse patellar fractures using a tensioned anterior figure-eight wire placed through two cannulated screws MATERIALS AND METHODS: 9 patients with displaced transverse patellar fractures treated with cannulated screws and figure-eight wiring were analyzed retrospectively. The mean age was 53 years (range, 22 to 68 years). Controlled passive range of motion exercise were started on the first postoperative day. Full weight bearing was allowed as tolerated. The patients were evaluated with radiographs, clinical examination and Levack's scoring system. RESULTS: All fractures healed and mean time elapsed for union was 9.4 weeks (range, 8 to 12 weeks). All patients regained full knee range of motion. Clinical results according to the Levack's scoring system were excellent in 8 cases and good in 1 case. We found no complications like loss of reduction and soft tissue irritation caused by the wire and screw, loosening or migration of hardware. CONCLUSION: Anterior figure-eight wiring through paired cannulated screws is appropriate for transverse patellar fractures, is possible early knee motion exercise and weight bearing.

Novel Vaccine Development against Escherichia coli O157: Immunologic Properties of O-Specific Polysaccharide-Shiga-like Toxin Conjugate Vaccines

Escherichia coli (E. coli) O157:H7 is an important cause of hemorrhagic colitis (HC) and hemolytic uremic syndrome (HUS). LPS-based vaccines need improvement since the anti-LPS antibodies raised by the vaccines are bactericidal and release toxin that may precipitate the development of HUS. Despite huge efforts, the treatment of infection with E. coli O157 has been difficult because antibiotics do not change the course of the enteritis caused by E. coli O157 and may increase the incidence of HUS through the release of Shiga-like toxin (Stx)-I. For this aim we tried the conjugate of E. coli O157 OSP bound to the nontoxic B subunit of Stx-I B as a vaccine that can induce both serum IgG anti-LPS antibody with bactericidal activity and neutralizing antibody to Stx-I. Mice were immunized s.c. with OSP-Stx-I B conjugate. Anti-sera were analyzed for the anti-LPS antibody, anti-Stx-I B antibody, complement-dependent bactericidal activity, and Stx-I neutralization activity. Mice injected with the bivalent conjugate elicited both bactericidal antibodies to E. coli O157 and neutralization antibodies to Stx-1. We also analyzed the distributional, functional changes of T lymphocytes in vitro and in vivo. After the injection of Stx-I, splenocytes showed a decrease in proliferation when stimulated with phytohemagglutinin (PHA) or LPS, and the number of CD4+ and CD8+ T cells also decreased. Interleukin (IL)-2, IL-4 and IFN-gamma productions by CD3+ T cells were slightly increased in the Stx-I injected mice.