Valgus-Flexion Osteotomy of the Proximal Femur in Childhood Hip Diseases / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of valgus-flexion femoral osteotomy (VFFO) in childhood hip diseases. MATERIALS AND METHODS: A VFFO was performed in 15 cases of childhood hip disorders with femoral head deformity: LCP disease (8); chronic SCFE (3); AVN after DDH (2), septic hip (1), femur neck fracture (1). Clinically, we evaluated the pre-and postoperative range of motion (ROM), pain, leg length discrepancy, and limping. Radiological evaluation included the neck-shaft angle, status of the osteotomy site and congruency of the femoral head with the acetabulum. Posterior displacement of femoral epiphysis was also evaluated in SCFE. RESULTS: An average 20.7degrees valgus and 23.0degrees, flexion osteotomy were performed. The average neck-shaft angle changed from 125.9degrees to 146.6degrees, The averaged ROM of the hip joint increased by 16.2degrees (flexion), 17.9degrees (abduction), 16.4degrees (adduction), 26.7degrees (internal rotation), and 15degrees (external rotation). Limitation of motion was greatly improved and the hip joint pain decreased. CONCLUSION: A VFFO of the proximal femur cannot only eliminate pain by making the best joint congruity, but can also help with the remodeling of a deformed femoral head. Moreover, an increased ROM can make a so-called "Yangban-Dali" possible, which makes daily activity as a Korean more comfortable.

Hypertrophic Non-union of the First Rib Causing Thoracic Outlet Syndrome: A Case Report

We experienced a rare case of thoracic outlet syndrome caused by hypertrophic nonunion of the first rib. A diagnosis was made mainly upon provocative tests and imaging studies. Pain and tingling could be reproduced and the radial pulse obliterated by the hyperabduction test. Abundant callus formation on the posterior aspect of the first rib with fracture line was visible on plain radiograph. Two-dimensional computed tomography showed right thoracic outlet narrowing mainly caused by the mass-effect of the callus. Dynamic arteriographic studies revealed an external compression of the right subclavian artery and duplex ultrasonography demonstrated a reduction in right subclavian artery blood flow when the shoulder is in 90 degrees of abduction. Surgery was performed after the conservative management for three months which failed to relieve the patient of his complaints. Resection of the first rib via transaxillary approach was undergone uneventfully in combination with the myotomy of the scalenus anticus muscle. At postoperative one year follow up, the patient was free of symptoms, and had a full range of motion of the right shoulder with no evidence of arterial insufficiency.

Cemented Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To clinically and radiologically assess cemented total knee arthroplasty. MATERIALS AND METHODS: Among the patients with rheumatoid arthritis or degenerative arthritis treated at the Department of Orthopaedic Surgery of Pusan National University Hospital by cemented total knee arthroplasty between January 1990 and October 1992, 21 patients (22 knees) were followed up for more than 5 years. The Knee Rating Scale of Hospital for Special Surgery was used for the clinical assessment and the American Knee Society Roentgenographic Evaluation and Scoring System was adopted for the radiological assessment. RESULTS: The average preoperative knee rating score was 46.4 and improved to 83.2 at the latest follow up. The average range of motion was 88 preoperatively and 120 at the latest follow up in rheumatoid arthritis. In degenerative arthritis, it was 104 preoperatively and 115 at the latest follow up. Four of 22 knees had radiolucent lines at the bone-cement interface, but most of them were nonprogressive and clinically insignificant. In conclusion, cemented TKA can be indicated for the painful arthritic knees in old patients. Rheumatoid arthritis showed better improvement in HSS knee score and ROM than degenerative arthritis. But, similar results were shown in the radiological assessment of rheumatoid arthritis and degenerative arthritis. CONCLUSIONS: Even though cemented TKA for the painful arthritic knee has shown good results, long-term follow up studies will be required to determine both the long-term clinical results as well as the radiological results.

Surgical Decompression of Tarsal Tunnel Syndrome / 대한정형외과학회잡지

PURPOSE: To find out the factors affecting prognosis after surgical decompression of tarsal tunnel syndrome. MATERIALS AND METHODS: We investigated and followed 11 patients in 12 cases with tarsal tunnel syndrome who underwent surgical decompression in our hospital over a 2-year and 6-month period. Diagnosis was based on the history, thorough physical examination and electrodiagnostic study. Recently, Magnetic Resonance Imaging has also been used to show in extraordinary detail both bony and soft tissue structures of ankle. Operation removed etiologic factors, decompression of flexor retinaculum and neurolysis of the posterior tibial nerve and its medial and lateral plantar nerve branches. It was particularly vital that the mobilization of the posterior tibial nerve be carried out distal to the overlying abductor hallucis. RESULTS: Electrodiagnostic evaluation showed reduced amplitude, increased duration of motor evoked potentials and decreased sensory conduction velocity, The postoperative result was assessed according to Takakura's rating scale. It was excellent in 3 cases, good in 6 cases, fair in 2 cases and poor in 1 case. CONCLUSIONS: The prognosis seemed to be related with age, duration of symptom and definite space occupying lesion.

Unreamed Interlocking Intramedullary nailing of open Tibial Shaft Fracture Initially Treated with External Fixation / 대한정형외과학회잡지

PURPOSE: To evaluate the treatment results, of open tibial shaft fracture assess its benefit and investigate ways to prevent deep infection or osteomyelitis. MATERIALS AND METHODS: Thirty-one cases of open tibial shaft fracture treated by primary external fixation and secondary unreamed interlocking intramedullary nailing were investigated and evaluated in terms of items such as fracture location, pattern, bony union, complications, etc. RESULTS: The most common cause was traffic accidents (23 cases, 74.2%), location was mid 1/3 (21 cases, 67.7%), pattern was comminuted one (16 cases, 51.6%) and open type was IIIb (14 cases, 45.1%). Duration of external fixation was 7.6 weeks in average, time interval to nailing after removal of external fixator was 15.7 days in average. Bony union was achieved within an average of 39.2 weeks after external fixation. Complications were 3 cases (9.7%) of delayed union, 5 cases (16.1%) of pin site infection, 1 case (3.2%) of deep infection, 2 cases (6.5%) of malunion and 2 cases (6.5%) of ankle stiffness. But nonunion and chronic osteomyelitis did not occur. CONCLUSION: This method enables early soft tissue reconstruction and minimizes delayed union and nonunion in the severely contaminated or injured open tibial shaft fracture. The timing of secondary nailing should be established under exact principle in order to prevent very serious complications such as deep infection and osteomyelitis.

Treatment of the Fractures of the Proximal Humerus / 대한정형외과학회잡지

The purpose of this study is to compare 76 cases of fractures of the proximal humerus both clinically and radiologically which were treated at Pusan National University Hospital from January 1987 to December 1996. According to Neers classification, among the 76 patients, there were nine one-part fractures (11.8%), forty two-part fractures (52.6%), eighteen three-part fractures (23.7%), four four-part fractures (5.3%), and five head-splitting fractures (6.6%). In terms of treatment method, among the 76 patients, 49 patients (64.5%) were treated conservatively. Thirty seven patients (75.5%) of one-part and two-part fractures were treated conservatively, and twelve patients (54.5%) of three-part and four-part fractures were treated operatively. The results of the cases were rated by the Neer s assessment, 42 patients (85.7%) had excellent or satisfactory results in one-part and two-part fracture, and 7 patients (31.8%) had unsatisfactory or failed results in three-part and four-part fracture. Total cases with complications were 14 cases (18.4%). From the viewpoint of the type of fracture, the results in two-part and three-part fractures were much better than those of fourpart fractures. The joint stiffness which was the most common complication must be prevented by allowing the early motion of the joint to obtain a better result.