Rotary Instability after Anterior Cruciate Ligament Reconstruction with Single BTB Tendon / 대한정형외과학회잡지

PURPOSE: To analyze both the functional restoration and recovery of rotational and anterior-posterior stability after a single bundle ACL reconstruction using a BTB tendon. MATERIALS AND METHODS: A total of 52 patients were evaluated with an average follow up period of 32 months. A Lachman test, KT-2000 arthrometer, and Pivot shift test were performed to analyze the AP and rotational stability of the patients. The IKDC and Lysholm score was then used to evaluate the clinical results of the patients. The correlation between femoral tunnel angle and recovery of rotational stability was evaluated to determine the association between the two variables. This study also evaluated how the recovery of rotational stability affects the functional recovery of the patients. RESULTS: At the final follow up, the results indicated significant improvement according to the negative Lachman tests in 40 cases (76%), with an average of 2.92 mm anterior translation in the KT-2000 arthrometer and negative Pivot shift tests in 41 cases (79%)(p<0.05). The Lysholm and IKDC scores also showed significant improvement (p<0.05). Throughout the study, Group A was designated as those with <5 mm anterior translation and a negative Pivot shift test whereas Group B had positive test results. In Group A, the results showed 35 normal (85%), and 6 near normal (15%) cases in the IKDC score system, whereas Group B showed 2 normal (25%) and 5 near normal (62.5%) cases. Group A had an average of 89.3 in the Lysholm score system whereas Group B had a score of 60.5. On the knee tunnel view, Group A showed an average femoral tunnel angle of 49.2degrees, whereas Group B showed 63.5degrees. CONCLUSION: Decreasing the inclination of the BTB tendon using a transtibial femoral tunnel angle at either 10'30 or 1'30 will result in an excellent clinical outcome by achieving both anterior and rotational stability when operating a single bundle ACL reconstruction.

Fixaton of Lesser Trochanteric Fragments on an Unstable Intertrochanteric Fracture of the Femur

PURPOSE: We evaluated the effect of cable fixation of the lesser trochanter for treating unstable intertrochanter fractures. MATERIALS AND METHODS: In this retrospective study, we assessed the availability of cable fixation of the lesser trochanter and the cause of complications in a series of 47 unstable intertrochanteric femoral fractures that were seen between February 2001 to May 2008 at our hospital. The fractures were classified using the Evans-Jensen classification system. The lesser trochanters were fixed in 21 cases. The correlations between the lag screw position, comminution of the fracture site and the radiological results were studied. Nonunion was diagnosed if patients experienced pain and the radiographs revealed a persistent, radiolucent defect at the fracture site 6 months after fracture fixation. RESULTS: Union was observed in 43 cases (91.5%). The average union time was 3.75 months. Nonunion was observed in 4 cases (8.5%) 1 in group l and 3 in group ll. The average sliding distance of the lag screw was 8.76 mm. In groups l and ll, the distance was 4.92 mm and 12.45 mm, respectively. Excessive sliding, which was defined as more than 15mm, developed in 9 cases, and 7 of these 9 cases were in group ll. The average neck-shaft angle change was 1.28degrees and 5.81degrees, respectively. CONCLUSION: Additional cable fixation of the lesser trochanter for treating intertrochanter fractures, including large posteromedial fragments, is recommended for preventing the excessive sliding of lag screws and varus deformity.

Using Suture Anchors in the Treatment of an Acromioclaviclar Dislocation / 대한정형외과학회잡지

PURPOSE: We introduce a surgical technique using suture anchors in the treatment of acromioclaviclar dislocation. MATERIALS AND METHODS: Eighteen patients, who underwent surgery (using a suture anchor) for an acute acromioclavicular joint dislocation, were followed up minimum of six months. The clinical results on Imatami clinical scoring and serial radiology findings were analyzed. RESULTS: Most of the cases showed satisfactory results. The clinical evaluation showed that seven cases (39%) were excellent and ten cases (56%) were good. Serial radiographic finding (preoperative, postoperative, postoperative 6 months) was evaluated. The mean preoperative, postoperative and postoperative 6 months coracoclavicular interval ratios were 2.41, 0.9 and 1.21, respectively. The early complications encountered were one case of a superficial infection at the insertion site of the smooth pin and one case of smooth pin migration. CONCLUSION: The use of suture anchors in the treatment of an acromioclaviclar dislocation is a superior method cosmetically due to the need for only a small operative incision, minimal destruction of acromioclaricular joint, secure fixation to early physical exercise and require additional surgery to remove the internal fixative.

Entrapment of the Sciatic Nerve in Femoral Subtrochanteric Fracture : A Case Report / 대한정형외과학회잡지

A sciatic nerve injury can arise from a penetrating injury of the thigh, a longstanding malposition or after hip arthroplasty. However, it rarely occurs after a subtrochanteric fracture of the femur. We report a case of sciatic nerve entrapment associated with a subtrochanteric fracture of the femur, which was aggravated after skeletal traction.