Usefulness of Synthetic Osteoconductive Bone Graft Substitute with Zeta Potential Control for Intramedullary Fixation with Proximal Femur Nail Antirotation in Osteoporotic Unstable Femoral Intertrochanteric Fracture / 대한고관절학회지

Purpose@#This study was conducted in order to examine the usefulness of osteoconductive bone substitutes with zeta potential control (geneX® ds; Biocomposites, England) by comparing the complications and radiographic evaluation with or without geneX® ds augmentation for internal fixation with proximal femur nail antirotation (PFNA) for treatment of osteoporotic unstable intertrochanteric fractures. @*Materials and Methods@#A retrospective study of 101 patients who underwent fixation with PFNA in osteoporotic unstable intertrochanteric fractures was conducted from December 2015 to August 2020. The radiographic evaluation and complication rates were compared between patients with geneX® ds (Group A: 41 cases) and those without geneX® ds (Group B: 60 cases). @*Results@#In radiological valuation, the degree of blade sliding from the time immediately after surgery to one year after surgery was 1.4±1.2 mm and 5.8±2.7 mm in Group A and Group B, respectively (P<0.001). During the same time frame, a significant difference of 2.3±2.2° and 7.4±3.1° , respectively (P<0.001), in varus collapse, was observed for Group A and Group B. @*Conclusion@#Among patients fixed with PFNA for treatment of unstable intertrochanteric fractures, less blade sliding and varus collapse was observed for those with geneX® ds augmentation compared to those without it. In addition, there was no increase in the incidence of complications. The authors believe it can be regarded as a safe and effective additive for intramedullary fixation for treatment of unstable intertrochanteric fractures.

Results of Anterior Cruciate Ligament Reconstruction Using Second Look Arthroscopic Examination: Focus on Graft Material and Age / 대한정형외과학회잡지

PURPOSE: We classified patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction into six groups according to graft material and age, and clinical, radiological, and second look arthroscopic results were compared and analyzed. MATERIALS AND METHODS: From January 2006 to December 2009, 57 patients underwent arthroscopic ACL reconstruction and second look arthroscopic examination. We divided patients according to graft materials into the autogenic hamstring tendon group (group 1) and the allogenic tibialis tendon group (group 2), and according to age into three groups (A, B, and C). The mean age at follow-up for second look arthroscopy was 34 years old. Fifty four patients were male and three patients were female, and mean follow-up period was 21.8 months. The result was clinically evaluated using a KT-1000 arthrometer under anesthesia, and the subjective and objective score of International Knee Documentation Committee (IKDC), and radiologically evaluated using the Telos(TM) stress test. We observed graft tension, synovialization and gross findings through a second look arthroscopic examination. RESULTS: The clinical and radiographic results in patients in group 1 and group A showed excellent finding, however, no statistically significant difference was observed. Second look arthroscopic examination in group 1 and group A showed excellent finding. In particular, the formation of synovialization showed excellent finding (50% or more synovialization) in 75% of patients in group 1A who were young and used an autogenic tendon graft, and 45% of patients in group 2C (over 50 years old and allogenic graft), and they were significantly different (p=0.046). There was significant difference in that tension of graft was excellent in group 1A (less than 3 mm). Through the IKDC evaluation method, 93% of cases that showed normal formation of synovialization and 50% of cases that showed inadequate formation of synovialization showed 'like normal' abnormality, so that was correlation was observed between synovialization and IKDC evaluation (p=0.001). CONCLUSION: Patients who used autogenic hamstring tendon and who were young showed excellent synovial membrane formation. In the old age group, autogenous graft will be more optimal.

Posterior Lumbar Interbody Fusion Using Compressive Bone Graft with Allograft and Autograft in the Pyogenic Discitis

STUDY DESIGN: This is a retrospective study. PURPOSE: To evaluate the advantages and effects of posterior lumbar interbody fusion (PLIF) using allograft and posterior instrumentation in the lumbar pyogenic discitis, which are resistant to antibiotics. OVERVIEW OF LITERATURE: To present preliminary results of PLIF using a compressive bone graft with allograft and pedicle screw fixation in the lumbar pyogenic discitis. METHODS: Fifteen patients who had lumbar pyogenic discitis were treated by posterior approach from May 2004 to July 2008. The mean follow-up duration was 27.2 +/- 18.68 months. The standing radiographs of the lumbar spine and clinical results were compared and analyzed in order to assess the bony union, the changes in the distance between the two vertebral bodies and the changes in the lordotic angle formed between the fused bodies immediately after surgery and at the final follow-up. RESULTS: Fifteen solid unions at an average of 15.2 +/- 3.5 weeks after operation. The mean preoperative lordotic angle of the affected segments was 14.3 +/- 15.1degrees, compared to 20.3 +/- 12.3degrees after surgery and 19.8 +/- 15.2degrees at last follow-up. For the functional result according to the Kirkaldy-Willis criteria, the outcome was excellent in 9, good in 5, fair in 1, and there were no poor cases. The average visual analogue scale score was decreased from 7.4 before surgery to 3.4 at 2 weeks postoperative. CONCLUSIONS: The main advantage in the procedure of PLIF using compressive bone graft with allograft and post instrumentation is early ambulation. We believe that this is another good procedure for patients with poor general condition because a further autograft bone harvest is not required.

The Prognostic Factor of Posterolateral Fusion in Degenerative Spondylolisthesis

STUDY DESIGN: A retrospective analysis of the posterolateral fusion in degenerative spondylolisthesis. OBJECTIVES: Posterolateral fusion has been performed for patients about Meyerding grade1, 2 with degenerative spondylolisthesis in L4-5. We evaluated the prognostic factors of posterolateral fusion, alone for degenerative spondylolisthesis. SUMMARY OF LITERATURE REVIEW: It is reported that posterolateral fusion has almost equal postoperative clinical and radiographic results with the interbody or circumferential fusion for spondylolisthesis. However, there have been some unsatisfactory results after posterolateral fusion alone and the causes are yet unknown. MATERIAL AND METHODS: From January 2002 to July 2008, we analyzed postoperative clinical outcomes of 42 patients who were diagnosed with Meyerding 1 or 2 grade degenerative spondylolisthesis at L4-5. All the patients were classified into group I and group II, based on the clinical outcome evaluation method by Kirkaldy-Willis. Ten patients (Group I) were found to have poor or fair clinical outcomes, while 32 patients (Group II) were found to have excellent or good clinical outcomes. The mean duration of the follow up was 16.3 (12-23) months. We looked into postoperative body mass index and bone mass density, and found degenrative lumbar disc through preoperative MRI, retrospectively. We measured angular motion by dynamic radiographs and preoperative slip angle through a Taillard method. RESULTS: In group I, the average preoperative BMI was 25.7 (21.2~31.4) and the average T score of bone density was -3.0 (-1.9~-4.2). There was 1 case of Grade 3, 3 cases of Grade 4 and 6 cases of Grade 5 by preoperative Pfirmann classification. The average angular motion was 11.8 (9.1~14.2) and the average preoperative slip angle was 8.4 (6.9-9.6). In group II, the average preoperative BMI was 24.3 (20.72~28.1) and the average T score of bone density was -2.1 (-0.9~-3.1). There were 26 cases of Grade 3, 5 cases of Grade 4 and 1 case of Grade 5 by preoperative Pfirmann classification. The average angular motion was 8.8 (6.2~12.1) and the average preoperative slip angle was 6.2 (3.6-7.9). There were statistically significant differences between the two groups in BMI, stage of disc degeneration, preoperative angular motion, and slip angle. (p=0.04, 0.04, 0.05, 0.03, respectively) CONCLUSION: We concluded that posterolateral fusion has exhibited worse clinical results in cases of BMI less than -2.8, disc degeneration greater than grade 4, angular motion greater than 9.4 degrees, and slip angle greater than 7.1 degrees; as such, we need to consider other surgical methods.

Autogenous Iliac Bone Grafting for the Treatment of Nonunion in the Hand Fracture

PURPOSE: To evaluate autogenous iliac bone graft for nonunion after hand fracture. MATERIALS AND METHODS: From October 2006 through September 2008, we analyzed 35 patients, 37 cases of autogenous iliac bone graft for nonunion after hand fracture that have followed up for more than 12 months. We analyzed about etiology, fracture site, initial treatment, time to bone graft, grafted bone size, grafted bone fixation method, radiologic time of bony healing and bone union rate retrospectively. Also we evaluated VAS and range of motion of each joints (MCP, PIP, DIP) at final follow-up assessment. RESULTS: Etiology was open fracture 23 cases (62.2%), crushing injury 12 cases (32.4%), direct trauma 2 cases (5.4%). Fracture site was metacarpal bone 7 cases, proximal phalanx 17 cases, middle phalanx 8 cases, distal phalanx 5 cases. Time to bone graft was average 20.7 weeks. Grafted bone fixation method was fixation with K-wire 27 cases (73.0%), fixation with only plate 6 cases (16.2%), fixation with K-wire plus plate 2 cases (5.4%), fixation with K-wire plus cerclage wiring 2 cases (5.4%). Grafted bone size was average 0.93 cm3 and bony union time was average 11.1 weeks and we had bone union in all cases. CONCLUSION: Autogenous iliac bone graft is the useful method in the reconstruction of non-union as complication after hand fracture.