Femoral Head and Neck Fractures developed in Avascular Necrosis of the Femoral Head

Femoral head and neck fractures during the course of avascular necrosis are rare with only few reports in the English literature. Moreover, there are very few reports on an analysis of the patterns of these fractures. Four cases of femoral head fracture caused by minor trauma, which were quite different from the crescent fractures during the course of avascular necrosis were analyzed in regard to the underlying disease, causes, sites, types, directions, pattern of fractures and the injury mechanism of the fractures. The results are reported with special regard to the pattern of the stress fracture of the femoral head and neck during the course of avascular necrosis.

Comparison between X-ray and Three Dimensional Computed Tomography in Trimalleolar Ankle Fractures

PURPOSE: To evaluate the accuracy of X-ray evaluation in classification, displacement and size of posterior malleolar fragment, comparing with three dimensional computed tomography (3D CT) in trimallelar ankle fractures. MATERIALS AND METHODS: 20 cases of trimalleolar ankle fractures evaluated with preoperative 3D CT, and followed up periods were at least 2 years. All cases were classified according to the Danis-Weber and Lauge-Hansen classification. Displacement and size of posterior malleolar fragment were measured using PACS. The reliability between simple X-ray and 3D CT was evaluated in the Danis-Weber and Lauge-Hansen classification (kappa analysis). The correlation between simple X-ray and 3D CT was evaluated in displacement and size of posterior malleolar fragment (correlation analysis). RESULTS: Degree of agreement of Danis-Weber classification in simple X-ray and 3D CT was 0.700 kappa value, and that of Lauge-Hansen was 0.605 kappa value. Measurement of simple X-ray and 3D CT about displaced status of posterior malleolar fragment showed statistically significant positive linear correlation (p= 0.000), but correlation of measurement of size in simple X-ray and CT was not statistically significant (p=0.102). CONCLUSION: CT or operative field will be more accurate than simple X-ray to select the method of treatment and operation, especially when the displacement and size of posterior malleolar fragment are important to decide.

The Effects of Dry Eye on the Corneal Thickness Measured by Orbscan and Ultrasonic Pachymetry

PURPOSE: To evaluate the effect of dry eye on the corneal thickness measured by Orbscan and ultrasonic pachymetry. METHODS: The central corneal thickness was measured by both ultrasonic and Orbscan pachymetry in 30 eyes with dry eye (dry eye group) and in 30 eyes of normal subjects (control group). Dry eye was diagnosed when a Schirmer test result was less than 10 mm (after topical anesthesia) and the test for tear osmolarity was also performed. RESULTS: Tear osmolarity was 364.4+/-42.9 mOsm/L in dry eye group and 337.8+/-34.5 mOsm/L in control group. It was significantly higher in dry eye group than in the control group (p=0.011). Mean central corneal thickness measured by Orbscan pachymetry was 547.5+/-27.3 microgram in dry eye group and 562.0+/-20.4 microgram in the control group. It was significantly thinner in dry eye group than in the control group (p=0.023). Mean central corneal thickness measured by ultrasonic pachymetry was 535.7+/-27.2 microgram in dry eye group and 547.6+/-20.1 microgram in the control group with out significant difference between the two groups (p=0.059). CONCLUSIONS: The corneal thickness measured by ultrasonic pachymetry is less affected by dry eye compared to that measured by Orbscan pachymetry.

Scleral Allograft with Autologous Buccal Mucosal Transplantation for Tube Erosion Ocurred after Ahmed Glaucoma Valve Implant Surgery: Three Cases

After Drainage implant surgery, erosion of conjunctiva or cornea over tube can occur about 5%in late postoperative period. Scleral allograft for exposed tube should be used to prevent secondary infection. We report three glaucoma patients treated graft with autologous buccal mucosal transplantation for recurrent tube exposure. First case was a 68-year-old male patient with neovascular glaucoma due to central retinal vein occlusion. Second case was a 37-year-old female patient with pseudophakic glaucoma. Third case was a 70-year-old male patient with diabetic neovascular glaucoma. Ahmed glaucoma valve implant surgeries were done for three patients. For tube exposure, we used autologous buccal mucosal transplantation. There was no recurrent erosion and intraocular pressure was maintained well more than 6 months of follow-up. In cases for tube exposure, we introduce that autologous buccal mucosal transplantation can be used to treat tube exposure.

Surgical Results of Levator Resection using the MLD (Margin Limbal Distance)in Congenital Blepharoptosis

In pediatric patients with congenital blepharoptosis, intraoperative decision of the amount of levator resection is difficult due to general anesthesia.We performed levator resection in 21 eyes of 17 patients with congenital blepharoptosis to evaluate the usefulness of the formula derived from the margin limbal distance (MLD)which was used to determine the amount of levator resection preoperatively. The amount of ptosis (interpalpebral fissure:IPF)was between 3.5 mm and 7.0 mm (mean 4.9 +/-1.2 mm), and less than 6.0 mm in 14 cases (66.4%).The levator function by Berke method was between 3.0 mm and 8.0 mm (mean 5.3 +/-1.7 mm), and between 5.0 mm and 8.0 mm in 13 cases (61.9%).The margin limbal distance was between 0 and 5.0 mm (mean 1.5 +/-1.4 mm), and less than 3.0 mm in 16 cases (76.2%).The amount of levator resection was between 10.0 mm and 22.0 mm, and between 16.0 mm and 18.0 mm in 10 cases (47.6%)which was most frequent. Of 4 patients (8 eyes)with bilateral blepharoptosis, excellent results (IPF > or= 8.0 mm)were achieved in 5 eyes (62.5%)and the other 3 eyes had fair results with IPF of over 6.0 mm.Three patients (75.0%)with bilateral blepharoptosis had symmetric IPF within 1.0 mm difference.In unilateral blepharoptosis, excellent results were achieved in 10 (76.9%)of 13 patients with IPF difference within 1.0 mm, and the other 3 patients had an IPF difference of 1.5 ~2.5 mm. The MLD formula gives the surgeon a good preoperative prediction of the amount of levator to resect, especially in pediatric patients with congenital blepharoptosis to undergo surgery under general anesthesia.