Ceramic on Ceramic Cementless Total Hip Arthroplasty with a 36 mm Diameter Femoral Head: More than Three Years Follow up / 대한고관절학회지

PURPOSE: The purpose of this study was to analyze the results for clinical outcome and radiologic assessment of ceramic on ceramic cementless total hip arthroplasty using a 36 mm diameter femoral head. MATERIALS AND METHODS: This study included a group of 40 patients of 43 cases who underwent ceramic on ceramic cementless total hip arthroplasty using a 36 mm diameter femoral head. The age range of this group was 28 to 82(mean 56); we monitored them over a period of 5.3 years(3-7.5 years). This clinical evaluation process included monitoring the degree of pain, range of motion, and the Harris hip score after three years since the surgery was performed. Radiographic evaluation and complication were confirmed as well. RESULTS: The preoperative Harris hip score increased from 43.4(21-57) to 88.1(81-95) after the surgery. The average motion range of hip was 113degrees flexion, 30degrees abduction, 24degrees adduction, 36degrees external rotation, and 12degrees internal rotation. Subjective pain was zero or minimal in all cases. Among the complications, dislocation occurred in only one case by a fall from a height and was reduced by closed reduction. There was no occurrence of ceramic fracture, even though infection occurred in one hip. CONCLUSION: The clinical outcome and radiologic assessment of the ceramic on ceramic cementless total hip arthroplasty using a 36 mm diameter femoral head showed a satisfactory result at three-year follow-up. Longer-term follow up is needed for further assessment.

Long-term Follow-up of Percutaneous Vertebroplasty in Osteoporotic Compression Fracture: Minimum of 5 Years Follow-up

STUDY DESIGN: This was designed as a retrospective study. PURPOSE: We assessed the radiographic and clinical outcome of patients who underwent percutaneous vertebroplasty (PVP) in osteoporotic compression fractures with a minimum of 5 years follow-up. OVERVIEW OF LITERATURE: Percutaneous vertebroplasty is effective surgical method for treating osteoporotic compression fracture. METHODS: Between January 2000 and August 2005, 159 patients were treated with PVP for osteoporotic compression fracture at our department; 43 patients died during follow-up, and 69 patients (121 vertebras) were available for follow-up for over 5 years. We analyzed the clinical and radiologic outcome including cement feature. RESULTS: The mean follow-up period was 5.7 years. Clinical outcome by mean visual analogue scale (VAS) score revealed a decreased 4.9 points perioperatively. A decreased score was maintained over 5 years in 46% of patients. A new adjacent vertebral fracture was documented by 33 vertebral bodies in 22 patients. During the follow-up period, 43 patients (38%) in 112 patients died. Anterior body heig ht in the last follow-up was improved about 0.3 mm compared with the preprocedural value, but was not statistically significant. Also, the focal kyphotic angle was reduced from 12.3degrees at the preprocedural state to 11.7degrees at the postprocedural state, but was not statistically significant (p > 0.05). CONCLUSIONS: PVP for osteoporotic compression fracture is an efficient procedure for pain relief by long term follow-up. The cement injected vertebrae showed stable radiologic progression without significant changes in vertebral height or kyphotic angle.

Treatment of the Posterior Malleolar Fracture Using Posterior Approach

PURPOSE: For fixation of the large posterior malleolar fracture fragment, indirect anterior fixation with cannulated screw has been widely used, but the anatomical reduction is not always obtained. The purpose of this article is to evaluate the clinical result of posterior malleolar fractures treated with anatomical reduction and internal fixation using posterior approach. MATERIALS AND METHODS: We have analyzed the 15 patients with posterior malleolar fractures, treated with posterior approach from August 2005 to August 2008. The mean follow up period was 17.6 months, We have reviewed the perioperative joint integrity, method of operation, postoperative care, bony union and complication. A clinical outcome was evaluated by AOFAS (American orthopedic foot and ankle society) scaling system and Olerud & Molander scoring system. RESULTS: Among 15 cases, posterolateral approach and posteromedial approach were chosen in 9 cases and 6 cases respectively. The radiologic unions were achieved at 12.4 (12~18) weeks. Mean AOFAS score was 90.3 (72~98), and Olerud & Molander score was "excellent" in 5 cases, "good" in 7 cases, "fair" in 1 case and "poor" in 2 cases. Postoperative complications in 2 cases revealed a posttraumatic arthritis and a scar band contracture respectively. CONCLUSION: In posterior malleolar fracture of ankle joint, the integrity of joint has closely affected clinical outcomes. We suggest that a posterior approach for posterior malleolar fracture with especially incarcerated fragments and comminuted fractures, can be a useful method for anatomical reduction and stable fixation, and satisfactory clinical results.

Impact of Weight Bearing Surface on Fractures of the Talus / 대한족부족관절학회지

PURPOSE: The fracture of talus has critical complications and results in various clinical outcomes. The purpose of this study is to evaluate clinical outcome and influence on involvement of ankle and subtalar joint. MATERIALS AND METHODS: From December 1999 to December 2008, a total of 66 fractures and dislocations of talus was treated with minimal 9 months follow up period. Ankle-hindfoot scale of the American Orthopedic Foot& Ankle Society (AOFAS) was used to evaluate the clinical outcome. The complications and sequential radiologic findings were also analyzed. RESULTS: There were 28 neck fractures, 11 lateral process fractures, 10 body fractures, 7 osteochondral fractures, 4 posteromedial tubercle fractures and 4 medial process fractures. In 38 cases, there were concomitant injuries. Ipsilateral ankle fracture, which found in 19 cases, was most common. The surgical treatment was performed in 36 cases. Mean AOFAS score was 85.5 (range, 72 to 96). In 13 of 47 cases, one or more fracture lines involving weight bearing surface were confirmed. The involvement of ankle or subtalar joint had resulted in unsatisfied outcome. Complications were developed as follows, post-traumatic arthritis in 8 cases, avascular necrosis in 3 cases, and deep infection in 2 cases. CONCLUSION: The involvement of ankle or subtalar joint in fractures of talus seemed to be common and to impact the clinical outcome. Meticulous consideration about that will be positively necessary.