Nonsurgical Treatment Strategies after Osteoporotic Hip Fractures / 대한고관절학회지

Osteoporosis is a metabolic disease that is increasing in prevalence as people live longer. Because the orthopedic surgeon is frequently the first and often the only physician to manage patients with osteoporotic hip fractures, every effort should be made to prevent future fractures. A multidisciplinary approach is essential in treatment of osteoporotic fractures. Basic treatment includes calcium and vitamin D supplementation, fall prevention, hip protection, and balance and exercise programs. Currently available pharmacologic agents are divided into antiresorptive and anabolic groups. Antiresorptive agents such as bisphosphonates limit bone resorption through inhibition of osteoclastic activity. Anabolic agents such as parathyroid hormone promote bone formation.

Comparison of Open and Arthroscopic Inferior Capsular Shifts for Multidirectional Instability of the Shoulder / 대한정형외과학회잡지

PURPOSE: To compare outcomes of open and arthroscopic inferior capsular shifts in multidirectional instability of the shoulder and to evaluate the factors affecting the outcomes. MATERIALS AND METHODS: We measured outcomes in 81 patients (84 shoulders) receiving open or arthroscopic inferior capsular shifts because of multidirectional instability of the shoulder from February, 1994, to April, 2006. There were 76 males and 8 females. Their mean age was 22 years at the time of surgery. The visual analogue scale (VAS) for pain, shoulder range of motion (ROM), and Rowe scores were evaluated preoperatively and postoperatively. RESULTS: In open surgery, the VAS for pain was 5.3 preoperatively and 2.1 postoperatively. VAS for instability changed from 4.6 to 1.7, and the average postoperative Rowe score was 83.7. Forward flexion was 173.7degrees preoperatively and 166.1degrees postoperatively. External rotation on the side changed from 75.5degrees to 62.7degrees. In arthroscopic surgery, the VAS for pain was 4.6 preoperatively and 1.2 postoperatively. VAS for instability changed from 5.9 to 1.2, and the average postoperative Rowe score was 87.4. Forward flexion was 169.5degrees preoperatively and 171.2degrees postoperatively. External rotation changed from 70.8degrees to 61.4degrees. CONCLUSION: Arthroscopic surgery was more effective in decreasing pain and conserving forward flexion of the shoulder than open surgery. Postoperative instability appeared to be related with generalized or bilateral shoulder joint laxity. Pain during motion after the operation was more significant during a voluntary subluxator. Low clinical scores were related with the operation on the dominant side or postoperative instability.

The Efficacy of Proximal Row Carpectomy / 대한정형외과학회잡지

PURPOSE: To evaluate the effects of proximal row carpectomy. MATERIALS AND METHODS: We performed a retrospective review of the cases of 14 patients who had undergone proximal row carpectomy between April 1996 and January 2006. All of the patients were men with an average age of 37.5 years (range, 25-64 years). The mean follow-up period was 59 months (range, 18-101months). Evaluation of results was based on x-ray analysis, pain relief, the ability to return to work, activity level, range of motion (ROM) and grip strength. Pain relief was classified as very satisfied, satisfied, dissatisfied and very dissatisfied. RESULTS: The subjective results of pain relief were very satisfied in 6 cases, satisfied in 7 cases, dissatisfied in 1 case. 7 cases (50%) returned to previous occupations and 11 cases (79%) had little restriction on their daily activities. The total arc was improved from average 42 degree to 59 degree. The grip strength using Jamar dynanometer was increased from average 7.8 lbs (10.5% of the unaffected side) to average 33 lbs (44% of the unaffected side). CONCLUSION: Proximal row carpectomy is an effective surgery with preserving ROM and function for patients with wrist pain and diminished function if it is done within proper indication.

Soft Tissue Coverage Using a Combined Gastrocnemius-medial Sural Artery Perforator Flap

Medial gastrocnemius flap has been known as a useful option for soft tissue reconstruction of the knee and upper 1/3 of lower extremity, but it has a limitation to cover the lateral defect of the knee joint. We performed the combined gastrocnemius-medial sural artery perforator flap for coverage of the anterolateral defects of the knee joint, which is compound flap using a medial gastrocnemius flap and a medial sural artery perforator flap. This flap is a useful method for reconstruction of anterolateral knee defects, providing a easy dissection without the microsurgery and intramuscular dissection of the perforators.