Evaluation of the Sigmoid Notch Involvement in the Intra-Articular Distal Radius Fractures: The Efficacy of Computed Tomography Compared with Plain X-ray

BACKGROUND: The purpose of this study is to evaluate the efficacy of computed tomography (CT) scans compared with plain radiographs on detecting the involvement of the sigmoid notch. METHODS: This study involved 121 cases diagnosed as the intra-articular distal radius fracture and performed post-reduction CT scans. We determined the presence of the sigmoid notch involvement with both plain radiographs and CT scans and compared findings of plain radiographs with CT scans about the incidence and the pattern of injuries. And the differences of results between arbeitsgemeinschaft fur osteosyntheses (AO) type C2 and C3 were compared. RESULTS: The incidences of sigmoid notch involvement detected in plain radiographs were 81 cases (66.9%), whereas CT scans were 99 cases (81.9%). The sensitivity of plain radiographs compared with CT scans was 74.7%, the specificity was 68.2%, the positive predictive value was 91.4%, the negative predictive value was 37.5%, the false negative value was 25.3%, and the false positive value was 31.8%. In comparison between AO type C2 and C3, the incidence of sigmoid notch involvement was not a significant difference, but the displacement of fracture fragment showed a significant difference. CONCLUSIONS: The intra-articular distal radius fracture usually accompanies the sigmoid notch involvement. Considering that the evaluation of sigmoid notch involvement by plain radiography often results in misinterpretation or underestimation, performing CT scan in intra-articular distal radius fracture is thought to be beneficial.

Evaluation of the Sigmoid Notch Involvement in the Intra-Articular Distal Radius Fractures: The Efficacy of Computed Tomography Compared with Plain X-ray

BACKGROUND: The purpose of this study is to evaluate the efficacy of computed tomography (CT) scans compared with plain radiographs on detecting the involvement of the sigmoid notch. METHODS: This study involved 121 cases diagnosed as the intra-articular distal radius fracture and performed post-reduction CT scans. We determined the presence of the sigmoid notch involvement with both plain radiographs and CT scans and compared findings of plain radiographs with CT scans about the incidence and the pattern of injuries. And the differences of results between arbeitsgemeinschaft fur osteosyntheses (AO) type C2 and C3 were compared. RESULTS: The incidences of sigmoid notch involvement detected in plain radiographs were 81 cases (66.9%), whereas CT scans were 99 cases (81.9%). The sensitivity of plain radiographs compared with CT scans was 74.7%, the specificity was 68.2%, the positive predictive value was 91.4%, the negative predictive value was 37.5%, the false negative value was 25.3%, and the false positive value was 31.8%. In comparison between AO type C2 and C3, the incidence of sigmoid notch involvement was not a significant difference, but the displacement of fracture fragment showed a significant difference. CONCLUSIONS: The intra-articular distal radius fracture usually accompanies the sigmoid notch involvement. Considering that the evaluation of sigmoid notch involvement by plain radiography often results in misinterpretation or underestimation, performing CT scan in intra-articular distal radius fracture is thought to be beneficial.

Femoral Neck Anteversion Measured Using a 3D CT Scan Perpendicular to the Mechanical Axis of the Femur

PURPOSE: We wanted to measure the femoral neck anteversion (FNA) angles using a 3D CT scan that perpendicularly cut the mechanical axis of the femur and to assess the accuracy and reproducibility of different measuring methods. MATERIALS AND METHODS: We obtained 95 cases of 3D CT images of the cross-section perpendicular to the mechanical axis of the femur. The methods used to measure the FNA angles included a method using the CT image of the area where the femoral neck is confluent to the greater trochanter (method 1), a method using the CT image taken from the neck base immediately prior to the beginning of the area of the lesser trochanter (method 2) and a method by which measurements are made after putting 3D bone models on a horizontal plane in virtual space (method 3). The reference axes of the distal femur we used were the anatomical transepicondylar axis, the surgical transepicondylar axis and the real posterior condylar axis. RESULTS: The FNA angles measured by method 1 were 4.79+/-6.41degrees to the anatomical transepicondylar axis (ATEA), 6.09+/-6.58degrees to the surgical transepicondylar axis (STEA) and 7.96+/-6.81degrees to the real posterior condylar axis (rPCA). The FNA angles measured by method 2 were 16.01+/-8.31degrees to the ATEA, 19.52+/-8.38degrees to the STEA and 21.79+/-8.52degrees to the rPCA. The FNA angles measured by method 3 were 20.15+/-12.89degrees to the rPCA. CONCLUSION: The measurement of the FNA angle using a 3D CT scan perpendicular to the mechanical axis is reproducible. The measurement method on the neck base level is more reliable than the one on the proximal neck confluence, and more similar to the measurement method by classic definition.

Changes in the Hand Strength and Related Factors after Carpal Tunnel Decompression / 대한정형외과학회잡지

PURPOSE: Our goal was to investigate an improvement in hand strength and its associated factors after carpal tunnel decompression in patients with carpal tunnel syndrome. MATERIALS AND METHODS: Between January 2008 and January 2009, a total of 31 patients (50 hands) treated with carpal tunnel decompression for carpal tunnel syndrome were enrolled into the study. Hand-strength was assessed pre- and post-surgery. In the pre-operation evaluation, we assessed multiple factors and investigated the association between these factors and recovery of hand strength. RESULTS: All patients regained hand strength after surgery. On average, the grip strength was 14.8 kg preoperatively, 13.0 kg at 6 weeks, 16.2 kg at 3 months, 18.7 kg at 6 months, and 20.6 kg at 1year postoperatively. The tip-pinch strength was 3.4 kg preoperatively and improved to 3.9 kg at 6 weeks, 4.0 kg at 3 months, 4.4 kg at 6 months and 4.7 kg at 1 year postoperatively. The key-pinch strength showed same pattern of improvement. The recovery of grip strength was significantly slower in patients with longer duration of carpal tunnel syndrome, with diabetes, or with nocturnal pain. There was no factor affecting the recovery of tip-pinch strength. Recovery of key-pinch strength was slower in patients that had experienced a longer duration of symptoms. CONCLUSION: Grip strength and pinch strength were recovered within 3 months and 6 weeks, respectively, after carpal tunnel decompression; both improved gradually until 12 months after surgery. Disease duration, diabetes, and nocturnal pain were significant factors that impacted on post-surgery recovery.

Contracture of Extensor Hallucis Longus Tendon Occurring after Intramedullary Nailing for a Tibial Fracture / 대한정형외과학회잡지

Toe deformities occurring after tibial shaft fracture can result from compartment syndrome or adhesion of muscle to tendon. Claw toes or checkrein deformity caused by injury of posterior compartment muscles has been reported relatively often. But, a deformity due to injury of the anterior compartment muscles is very rare. We observed the two cases of an extension deformity at the metatarsophalangeal joint of the hallux following intramedullary nailing of a tibial shaft fracture. There was no evidence of compartment syndrome. Extension deformity of the hallux was decreased with dorsiflexion of the ankle and increased with plantar flexion. Contracture of the extensor hallucis longus tendon was diagnosed, and Z-lengthening of that tendon was performed. Satisfactory results were obtained without a recurrence of deformity. We report these rare cases of toe deformities occurring after a tibial shaft fracture, with a brief review of the literature.

Ultrasound-guided supraclavicular brachial plexus block in pediatric patients: A report of four cases / 대한마취과학회지

Supraclavicular brachial plexus blocks are not common in pediatric patients due to the risk of pneumothorax. Ultrasonography is an important tool for identifying nerves during regional anesthesia. Directly visualizing the target nerves and monitoring the distribution of the local anesthetic are potentially significant. In addition, ultrasound monitoring helps avoid complications, such as inadvertent intravascular injection or pneumothorax. This paper reports four cases of pediatric patients who received ultrasound-guided supraclavicular brachial plexus block for upper limb surgery.

Extraarticular Subtalar Arthrodesis for Pes Planovalgus: An Interim Result of 50 Feet in Patients with Spastic Diplegia

BACKGROUND: There are no reports of the pressure changes across the foot after extraarticular subtalar arthrodesis for a planovalgus foot deformity in cerebral palsy. This paper reviews our results of extraarticular subtalar arthrodesis using a cannulated screw and cancellous bone graft. METHODS: Fifty planovalgus feet in 30 patients with spastic diplegia were included. The mean age at the time of surgery was 9 years, and the mean follow-up period was 3 years. The radiographic, gait, and dynamic foot pressure changes after surgery were investigated. RESULTS: All patients showed union and no recurrence of the deformity. Correction of the abduction of the forefoot, subluxation of the talonavicular joint, and the hindfoot valgus was confirmed radiographically. However, the calcaneal pitch was not improved significantly after surgery. Peak dorsiflexion of the ankle during the stance phase was increased after surgery, and the peak plantarflexion at push off was decreased. The peak ankle plantar flexion moment and power were also decreased. Postoperative elevation of the medial longitudinal arch was expressed as a decreased relative vertical impulse of the medial midfoot and an increased relative vertical impulse (RVI) of the lateral midfoot. However, the lower than normal RVI of the 1st and 2nd metatarsal head after surgery suggested uncorrected forefoot supination. The anteroposterior and lateral paths of the center of pressure were improved postoperatively. CONCLUSIONS: Our experience suggests that the index operation reliably corrects the hindfoot valgus in patients with spastic diplegia. Although the operation corrects the plantar flexion of the talus, it does not necessarily correct the plantarflexed calcaneus and forefoot supination. However, these findings are short-term and longer term observations will be needed.

Comparison of Kyphoplasty and Lordoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture

STUDY DESIGN: A retrospective study. PURPOSE: To compare the level of restoration of the vertebral height, improvement in the wedge and kyphotic angles, and the incidence of complications in osteoporotic compression fracture in patients treated with either kyphoplasty or lordoplasty. OVERVIEW OF LITERATURE: Kyphoplasty involves recompression of the vertebral bodies. Recently, a more effective method known as lordoplasty was introduced. METHODS: Between 2004 and 2009, patients with osteoporotic thoracolumbar vertebral compression fractures were treated by either kyphoplasty (n = 24) or lordoplasty (n = 12) using polymethylmethacrylate (PMMA) cement, and the results of the two interventions were compared. A visual analogue scale was used to measure the pain status. Preoperative and postoperative radiographs were analyzed to quantify the anterior vertebral height restoration and the wedge and kyphotic alignment correction. RESULTS: All patients in both groups reported a significant decrease in pain. The anterior heights increased 24.2% and 17.5% after the lordoplasty and kyphoplasty procedures, respectively (p < 0.05). Three months after the procedures, there was a larger decrease in the loss of anterior vertebral height in the kyphoplasty group (12.8%) than in the lordoplasty group (6.3%, p < 0.05). The wedge angles decreased after both procedures. The wedge angle in the lordoplasty group maintained its value after 3 months (p < 0.05). The kyphotic angular correction was 11.4 and 7.0degrees in the lordoplasty and kyphoplasty groups, respectively (p < 0.05). Both kyphotic deformities worsened to a similar degree of 5degrees after 3 months. CONCLUSIONS: Lordoplasty is more useful than kyphoplasty in terms of the improved anatomic restoration and postoperative maintenance.

Chronic Post-traumatic Inflammatory Tenosynovitis of the Finger Joint

PURPOSE: Chronic inflammatory tenosynovitis (CITS) involving the finger joint after trauma has been rarely reported. This study reports the surgical results of ten patients with CITS. MATERIALS AND METHODS: From March 2007 to June 2009, ten patients with pain, swelling and limitation of motion of the finger were diagnosed as CITS. All patients had a history of direct injury. The operation was performed at a mean of 6.6 months after the onset of symptom. Average range of motion was 54 degrees in five patients with CITS of the metacarpophalangeal joint and was 44 degrees in five patients with that of the proximal interphalangeal joint. The mean follow-up duration was 15 months. Two of ten patints showed the involvement of the bone. Tenosynovectomy was performed and four patients required volar and dorsal double incisions. In cases of the bony invasion, multiple drilling and curettage was done. RESULTS: Postoperatively, all patients showed improvement of pain and swelling and did not show recurrence. The magnetic resonance image was carried out in all patients and showed the inflammatory changes of the tendosynovium and joint capsule. Culture and PCR test for tuberculosis showed negative findings in all cases. However, anti-tuberculosis chemotheraphy for nine months was applied to three patients who showed caseous necrosis or rice body in biopsy. The mean range of motion was 66 degrees in metacarpophalangeal joint and 53 degrees in proximal interphalangeal joint. CONCLUSIONS: Magnetic resonance image appears helpful in the diagnosis and the treatment of CITS which involved the joint of hand and the operative treatment can improve the symptoms and clinical outcomes.

Treatment of Femoral Shaft Fracture with Interlocking Humeral Nail in Older Children and Adolescent

PURPOSE: To evaluate the results of interlocking humeral nail for femur shaft fractures through the greater trochanter in older children and adolescent. MATERIALS AND METHODS: Eleven femoral shaft fractures in ten patients were selected. They were consisted of 9 boys and 1 girl. Two patients had osteogenesis imperfecta and one patient had a simple bone cyst as an underlying disease. 7 cases were right side and 4 cases were left side. The mean age at the time of operation was 12 years and 7 months (8 years 11 months~15 years 7 months). The mean follow-up period was 21 months and interlocking humeral nail was inserted at the greater trochanter in all patients. RESULTS: All patients had a complete bony union without any complication such as infection, nonunion, leg length discrepancy and metal failure. Avascular necrosis of femoral head and coxa valga were not developed in all patients. CONCLUSION: Intramedullary nailing through the greater trochanter using interlocking humeral nail is effective and safe treatment for the femoral shaft fracture in older children and adolescents.

Altered Synthesis of Cartilage-Specific Proteoglycans by Mutant Human Cartilage Oligomeric Matrix Protein

BACKGROUND: The mechanism by which mutant cartilage oligomeric matrix protein (COMP) induces a pseudoachondroplasia phenotype remains unknown, and the reason why a mutation of a minor protein of the growth plate cartilage causes total disruption of endochondral bone formation has not yet been determined. The current study was performed to investigate the effects of mutated COMP on the synthesis of the cartilage-specific major matrix proteins of Swarm rat chondrosarcoma chondrocytes. METHODS: The Swarm rat chondrosarcoma chondrocytes transfected with a chimeric construct, which consisted of a mutant gene of human COMP and an amino acid FLAG tag sequence, were cultured in agarose gel. Formation of extracellular proteoglycan and type-II collagen by the cells was evaluated by immunohistochemical staining and measuring the (35)S-sulfate incorporation. RESULTS: No difference was observed for the detection of type-II collagen among the cell lines expressing mutant COMP and the control cell lines. Histochemical staining of sulfated proteoglycans with safranin-O showed that lesser amounts of proteoglycans were incorporated into the extracellular matrix of the chondrocytes transfected with the mutant gene. (35)S-sulfate incorporation into the cell/matrix fractions demonstrated markedly lower radiolabel incorporation, as compared to that of the control cells. CONCLUSIONS: Mutation of COMP has an important impact on the processing of proteoglycans, rather than type-II collagen, in the three-dimensional culture of Swarm rat chondrosarcoma chondrocytes.

The Function and Symptoms of Ankle Joint in the Distal Tibial Fractures Treated by Nailing / 대한족부족관절학회지

PURPOSE: To evaluate the safety and prognostic factors of intramedullary nailing of distal tibia fractures in terms of function and symptoms of the ankle joint. MATERIALS AND METHODS: We retrospectively analyzed 22 distal tibial fractures with intramedullary nailing. The mean duration of follow-up was 43 months. We reviewed medical records to describe each case. We measured radiographic parameters such as fracture configuration, arthritic change of the ankle joint and status of reduction. We also assessed clinical results by AOFAS ankle hind foot scoring system, degree of pain by VAS and range of motion to find out prognostic factors for functional result of the ankle joint. RESULTS: Bone healing was obtained in all cases without any wound complications. Mean AOFAS ankle score was 94. There were 4 cases with mild (VAS<3/10) ankle pain and 2 cases with mild limitation of ankle motion. The comminution of fracture had a significant relationship with delayed angular deformity of ankle joint (p=0.032). There was no other significant parameter affecting ankle joint function except the location of nail-end. CONCLUSION: Intramedullary nailing in distal tibia fracture is a safe and effective procedure. But further study may need to evaluate the relationship between the position of nail-end and the function of ankle joint.

Bone Transport Over the Intramedullary Nail for Defects of Long Bone

PURPOSE: To evaluate the results of bone transport using external fixator over an intramedullary nail for defects of long bone. MATERIALS AND METHODS: We treated 14 cases of bone defect after chronic osteomyelitis or trauma of tibia (12 cases) and femur (2 cases) using this method. The mean age of index procedure was 46.9 years, and all of them had follow-up study for a mean of 3 years. After the corticotomy and insertion of intramedullary nail, bone transport was done by external fixators. Then, the segment was moved and bone graft was done at docking site. RESULTS: The mean transported amount was 5.8 cm, and the external fixator was removed after 141 days. The mean external fixation index was 25.6 days/cm. Primary union of distraction and docking site was achieved in all, but one had failure in union of docking site. According to the Mekhail's functional criteria, there were 5 excellent, 6 good, and 3 fair results. Among 15 complications, there were 2 major complications with residual sequelae, and they were 1 recurred osteomyelitis and 1 flexion contracture of knee. CONCLUSION: Bone transport using external fixator over an intramedullary nail, can successfully solve defects of long bone. Since this method can remove external fixators earlier than the conventional method, it has fewer complications and makes patients to return to daily life earlier.

3.5 mm T-shaped LCP (Locking Compression Plate) Fixation for Unstable Distal Clavicular Fractures

PURPOSE: To review the clinical and radiological results after an open reduction and internal fixation with a T-shaped LCP for unstable distal clavicle fractures. MATERIALS AND METHODS: From February 2005 to June 2006, ten patients with distal clavicle Neer type II fractures were treated with an open reduction and internal fixation with a T-shaped LCP. Bony union was identified by plain radiography. The clinical results were analyzed according to the UCLA scoring system. RESULTS: The mean time to fracture union was 9weeks and union was achieved in all cases. The mean UCLA score was 33.4 (30-35); excellent in 8 cases and good in 2 cases. In one case, loosening of one distal screw was occured and mild AC joint subluxation was observed in another case. CONCLUSION: 3.5 mm T-shaped LCP fixation is a useful technique for treating unstable distal clavicle fractures. This procedure provide stable fixation with no further AC joint injury.

The Effect of Patellar Position on the Flexion Gap in Total Knee Arthroplasty

PURPOSE: The aim of this study was to investigate the relationship between eversion or reduction of patella and the heights of the extension or flexion gaps. MATERIALS AND METHODS: Measurements of the heights of the extension and flexion gaps were obtained during 32 primary posterior-stabilized total knee arthroplasties in 25 osteoarthritic patients. A tensor device was introduced after femoral and tibial bony resections while putting the knees flat on the operating table to measure the extension gaps in the medial and lateral compartments, respectively. The knee was flexed 95 degrees, and the tensor was introduced to measure the flexion gaps in the same manner. A calibrated torque wrench permitted the application of the force of about 113.4N.cm both in extension and in flexion in right knee, and of about 152.4N.cm both in extension and in flexion in left knee. RESULTS: The average height of the extension gap with everted patella was 20.9+/-2.6mm medially and 23.6+/-2.5 mm laterally, respectively. The average height of the extension gap with reduced patella was 21.0+/-2.6mm medially and 23.7+/-2.4mm laterally, respectively. The average height of the flexion gap with everted patella was 20.7+/-2.5mm medially and 23.2+/-2.8mm laterally, respectively. The average height of the flexion gap with reduced patella was 22.1+/-2.3mm medially and 24.2+/-2.8mm laterally, respectively. After reducing the patella, the flexion gap height increased an average 1.4+/-1.1(range: 0~4)mm and 1.0+/-1.2(range: -1~3)mm in the medial and lateral compartments, respectively. CONCLUSION: The height of flexion gap would be increased by reducing the patella from everted position in posterior- stabilized total knee arthroplasty for the patient with good preoperative flexion. The flexion gap must be observed not with everted patella but with reduced patella to determine whether it appears symmetric and balanced.

Results of Revision Hip Arthroplasty using Cemented Femoral Stem

PURPOSE: To analyze clinical and radiological follow-up results of patients who underwent revision hip arthroplasty with a cemented stem. MATERIALS AND METHODS: This study reviewed the records of 31 patients (34 hips), who underwent revision hip arthroplasty with a cemented stem between February, 1993 and May, 2004 after an average follow-up of eight years. There were 14 segmental type hips according to the femoral bone defect using the AAOS classification. According to the Paprosky classification, there were 7 and 5 type IIC and type III hips indicating a severe bone defect. Immediate postoperative cement mantle grades were grades A and B(26 hips) and grade C, D(8 hips). RESULTS: The Kaplan Meier survival rate of the cemented stem was 80.7% at 8 years. Re-revision hip arthroplasty was performed in 5 hips, in whom aseptic loosening occurred 4 hips, and infection occurred 1 hip, which was cured by re-surgery. Immediately after the operation, 4 out of the 5 re-revision cases were classified as C & D in the Barrack classification of the cement mantle. Overall, an inadequate cement mantle led to a poorer survival rate. CONCLUSION: The results of revision hip arthroplasty using a cemented stem were not so good. However, the cemented stem might be used in cases considered unsuitable for a cementless stem if a good cement mantle could be achieved using a skillful cement technique.

The Effect of Lateral Retinacular Peeling in Total Knee Arthroplasty

PURPOSE: The aim of the present study was to investigate if a lateral retinacular peeling helped decrease the amount of lateral patellar tilt in total knee arthroplasty (TKA). MATERIALS AND METHODS: The lateral tilt angles were measured in tangential radiographs made preoperatively and postoperatively, with the knee in 100 degrees of flexion, in an earlier series of 38 TKAs(Group 1) and a series of 53 TKAs (Group 2) that included lateral retinacular peel and partial facetectomy. RESULTS: The mean preoperative patellar tilt angle was 9.1+/-4.5 degrees in the group 1 and 9.5+/-5.2 degrees in the group 2. The mean postoperative patellar tilt angle was 12.8 +/-6.2 and 11.0+/-7.1 degrees, respectively. The implant tilt angle was 6.3+/-7.3 and 5.5+/-6.1 degrees, respectively. The differences between two groups were not statistically significant. CONCLUSION: The patella would tilt laterally following total knee arthroplasty. A lateral retinacular peeling had no discernible effect on the postoperative lateral tilt of the resurfaced patella.

5-12 Year Results of Femoral Revision Total Hip Arthroplasty using the Wagner Revision Stem / 대한정형외과학회잡지

PURPOSE: To analyze the results of a 5-12 year (mean, 7 years, 5 months) follow-up of femoral revision THA using the Wagner(R) stem. MATERIALS AND METHODS: Of 79 revision THA patients enrolled in the study between March 1991 and January 2000, there were 64 cases of aseptic loosening (69 hips, 44 males and 20 females) during a minimum 5-year follow-up. In addition, postoperative complications and clinical and radiographic results were evaluated. RESULTS: The Harris hip score improved from 48.6 to 91.2 points, postoperatively. There were 3 revisions due to failed stem fixation and aseptic loosening. The Kaplan-Meier survivorship analysis, with failure defined as a removal of the Wagner(R) stem, revealed a 97.1% survival at a 12-year follow-up. Besides the revisions, there were 66 hips that were hip-related symptom-free. However, there was claudication in 1 case. Radiographic findings included subsidence of the implant (5 cases, 7.5%, all less than 10 mm), calcar femorale atrophy (4 cases, 6.0%), stress shielding (4 cases, 6.0%), and heterotopic ossification (5 cases, 7.5%). Postoperative peroneal nerve palsy (2 cases) resolved completely within the following 6 months. CONCLUSION: We obtained a stable fixation and satisfactory results in the cases we studied using the Wagner(R) revision stem.

Treatment of Chronic Cavitary Osteomyelitis with Fragmentary Partial Bone Transport: A Report of New Operative Technique / 대한정형외과학회잡지

PURPOSE: To report the challenging problems in the treatment of patients with chronic cavitary osteomyelitis that is refractory to conventional treatment methods, and to illustrate the author's newly designed fragmentary partial bone transport technique using the modification of the Ilizarov method. MATERIALS AND METHODS: Three patients with chronic cavitary osteomyelitis with a large cavitary bone defect of the tibia were treated with the author's newly designed biological fragmentary partial bone transport technique. RESULTS: After an average of 78 days of fragmentary partial bone transport, the cavitary bone defects were completely filled with the transported bone fragment, and the draining sinus disappeared without any evidence of active infection. The Ilizarov frame was removed on an average of 271.3 days after surgery. The mean total length of the distraction was 8.0 cm and the mean healing index was 33.9 days/cm. CONCLUSION: A fragmentary partial bone transport technique using the Ilizarov apparatus can solve the problem of chronic cavitary osteomyelitis of the tibia by filling the bone defect with new living bone without sacrificing the bony continuity and effectively eradicating the infection. Therefore, this new technique is an effective treatment for chronic cavitary osteomyelitis of the tibia.

The Posterior Fixation of Thoracolumbar Burst Fracture using Pedicle Screws and Caudal Offset Sublaminar Hooks / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: We analyzed the clinical results of thoracolumbar burst fractures, managed by posterior fixation of 2 segments above and 1 segment below, using an offset sublaminar hook. SUMMARY OF LITERATURE REVIEW: Mono-segment fixation above and below the injured vertebra, using posterior pedicle screw fixation, has the benefit of saving the uninjured mobile lumbar segment in thoracolumbar junction burst fracture patients. However, in a severely comminuted vertebral body, mono-segment fixation may not prevent loss of correction and metal failure. Options for such cases are additional anterior column support or long segment fixation, including 2 segments above and 1 below the injured vertebra. Instead of fixing 2 segments below the fracture level, fixation of one segment below, using the offset sublaminar hook, can save the uninjured segment, especially in the upper lumbar segment, with greater fixation strength than mono-segmental screws only. MATERIAL AND METHOD: The study included eleven patients with a thoracolumbar junction burst fracture, which underwent posterior fixation using pedicle screws in 2 segments above and 1 segment below, aided by an offset sublaminar hook. The mean follow-up period was 30.7 months (range, 24 to 58 months). Radiographs taken at follow-up were evaluated for implant loosening, correction loss, change in pedicle screw angle, and loss of vertebral height, adjacent segment instability and junctional degenerative change. The clinical results were collected in out-patient department. RESULTS: No implant loosening was noted. No case showed adjacent instability, acceleration of junctional degenerative change at the lower end of lumbar segment or hook dislodgement. Also, there were no junctional area related symptoms. CONCLUSION: For posterior surgery of thoracolumbar burst fractures, this construct, fixing 2 segments above and 1 segment below injured vertebra, aided by an offset sublaminar hook, was satisfactory in maintaining fracture reduction, and showed no instability or acceleration of degeneration on adjacent segnents.