Comparison of Bending Strength of Six Different Type of the First Metatarsal Osteotomies / 대한정형외과학회잡지

PURPOSE: We compare the sagittal stability of 6 different osteotomies of the metatarsal shaft : the proximal crescentic, proximal chevron, Mau, Scarf, Ludloff, and biplanar closing wedge osteotomies. MATERIALS AND METHODS: Ten fresh frozen, human cadaveric specimens were used for each osteotomy. All specimens were then dissected out en bloc as the first metatarsal -medial cuneiform complex which was fixed with 3 Kirschner wires and clamped to a MTS Mini Bionix load frame. Cantiliver bending load was applied until bony fracture, pull out of screw, or a displacement of osteotomy greater than 2 mm as measured by the extensometer was observed. The data was compared with Student's t-test. RESULTS: The average bending strength for 6 osteotomies were 199.56 kg/cm2 in proximal crescentic osteotomy, 205.3 kg/cm2 in proximal chevron osteotomy, 372.0 kg/cm2 in Ludloff osteotomy, 428.4 kg/cm2 in Scarf osteotomy, 508.8 kg/cm2 in biplanar closing osteotomy, and 530.0 kg/cm2 in Mau osteotomy. Statistical analysis revealed insignificant difference (P>0.01) between Ludloff and Scarf and biplanar closing wedge and Mau osteotomies. There were statistical differences between Mau or Scarf osteotomy and proximal chevron or crescentic osteotomy. CONCLUSION: Proximal chevron and proximal crescentic osteotomies need longer postoperative immobilization for the prevention of plantar angulation of first metatasus.

Fixation of Infected Nonunion of Femur by a Kuntscher Nail Stuffed with Antibiotic Laden Bone Cement: A Case Report / 대한정형외과학회잡지

A case of established infected nonunion of femur after open reduction and internal fixation of proximal femoral fracture with plate and screws in a 20-year-old man has been satisfactorily treated with a conventional Kiintscher nail filled with antibiotic laden bone cement in its hollow cavity. Though the removal of plate and screws, wound debridement, insertion of antibiotic laden bone cement bead at the nonunion site with temporary external skeletal fixation and skeletal traction preceded, a rigid fixation by the nail and vancomycin elution from the cement are believed to have contributed for bony union without troublesome complication of infection in this case.