Upper Extremity Reconstruction Surgery for the Persons with Tetraplegia: Current Status and Solutions to Promote the Procedures in Korea

OBJECTIVE: To know the present status of upper extremity reconstruction surgery for the person with tetraplegia in Korea and to suggest solutions to promote the procedures. METHOD: 62 physiatrists and 42 hand surgeons were surveyed with self administered questionnaire. The questionnaire was made up of 5 categories: (1) whether physicians had experienced these procedures in the past three years, (2) if they have had no experience, what the reasons were, (3) whether physicians desired to be involved in these procedures, (4) what the solution to promote these procedures should be, (5) the attitudes and beliefs of physicians about these procedures. The last category was analyzed by odds ratio between physicians who desired to be involved in the procedure and who didn't. RESULTS: Only two physiatrists and six surgeons had experienced these procedures in the past three years. However many physicians desired to be involved in these procedures. The main reason of not performing these procedures was a lack of referral between physiatrists and surgeons. The physicians who desire to practice upper extremity reconstruction surgery or related rehabilitation had higher confidence on the benefits of the procedures and thought that they had knowledge and skills for the procedure. CONCLUSION: In spite of positive attitude to the upper extremity reconstruction for tetraplegic patients, few physicians have experienced in these procedures. This phenomenon was due to a lack of referral between physiatrists and surgeons. Advancing cross-specialty relationships and educating related physicians could be solutions to promote these procedures.

Hemiarthoplasty with Bone Block Graft and Low Profile Prosthesis for the Comminuted Proximal Humerus Fractures

PURPOSE: To evaluate the outcome of hemiarthroplasty with bone block graft and low profile prosthesis (Aequalis(R) fracture prosthesis) for the comminuted proximal humerus fractures. MATERIALS AND METHODS: Sixteen low profile prostheses were used since July 2004, and 11 patients were followed-up for average 19.9 (12~30) months. Their mean age was 67.3 (52~78) years. Pain and satisfaction visual analog scale (VAS), range of motion, and modified UCLA score for hemiarthroplasty were evaluated at every visit. Radiography was also checked for stem position, loosening, and tuberosity union. RESULTS: Mean pain VAS was 2.7 (0~5), and mean satisfaction VAS was 8.4 (5~10). Mean active forward flexion was 137 degrees (90~170), external rotation at side was 45.5 degrees (25~70), and internal rotation at back was T10 (T7~L1). Modified UCLA score was 19 (12~30) at final visit. All stems were stable, and there were no loosening at the final follow-up. All tuberosities were united except two tuberosity absorptions. CONCLUSION: The outcome of hemiarthroplasty with bone block graft and low profile prosthesis was comparable to other implants for comminuted proximal humerus fractures. This system had unique advantages for tuberosity union. Further study with more patients and longer follow-up are necessary to clarify the effectiveness of this prosthesis.

The Result of the Modified Extension Block Technique in Bony Mallet Finger

PURPOSE: To evaluate the treatment outcomes of the modified extension block technique for bony mallet finger. MATERIALS AND METHODS: This study included 16 patients who had been treated with the modified extension block technique for bony mallet finger from December 2002 to January 2004. The average duration of follow up was 13 (12~17) months. The indication of operation was the presence of a large bony fragment invading more than 1/3 of the articular surface or the palmar subluxation in the distal interphalangeal joint. RESULTS: The average extension lag was 2.3 degrees, and the range of motion of the distal interphalangeal joint was 68.8 degrees. Radiograph showed bony union state in all cases. By the Crawford's evaluation criteria, 12 cases (75%) was excellent or good. Postoperative complications occurred in 3 cases, which were reduction loss within postoperative 2 weeks in 2 cases and mild pain with motion in 1 case. CONCLUSION: The modified extension block technique is a easy and simple method. It shows a good result without complications from skin incision. So, it seems a useful method for bony mallet finger.

The Result of Autologous Osteochondral Grafting for the Osteochondral Lesion of the Talus / 대한족부족관절학회지

PURPOSE: The purpose of this study is to assess the results of the autologous osteochondral grafting for the osteochondral lesion of the talus. MATERIALS AND METHODS: This study included 21 patient who had been treated with the open autologous osteochondral grafting between December, 1999 and December 2003. We treated the patients with autologous osteochondral grafting method who had the lesion of stage II or medial lesion of stage III without improvement for at least 6 months, the medial lesion of stage IV, the lateral lesion of stage III, IV by Berndt and Harty's classification or who had not improved with previous operation. The average duration of follow up was 26 (12-56) months. 6 patients had been treated with the previous operation that 3 patients with drilling, 3 patients excision, curettage and drilling. RESULTS: The average AOFAS Ankle/Hindfoot score was 92.7 points and no patient had a limitation of the daily activities due to pain or abnormal function. Postoperative radiography showed good joint congruency and postoperative MRI good incorporation of the graft. The average Lysholm knee score was 96 points and only two patients had mild knee pain during severe exertion. CONCLUSION: The autologous osteochondral grafting is the useful operative method when the lesion is advanced stage or when previous operative treatment has failed.