Treatment of Calcaneovalgus Deformity Following Operative Treatment of Diplegic Equinovarus Deformity in Cerebral Palsy Patient: A Case Report / 대한족부족관절학회지

Calcaneal or calcaneovalgus deformity can occur after surgical treatment of equinus or eguinovarus deformity in cerebral palsy patient. It is a serious complication and the results of many conservative and operative treatments are reported unsatisfactory. We experienced one case of both calcaneovalgus deformity following operative treatment of diplegic equinovarus deformity in a spastic cerebral palsy patient and report about the result of the treatment.

4+5 Extensor Compartmental Vascularized Bone Graft for Stage III Kienbock's Disease : Preliminary Results

PURPOSE: The aim of this study was to evaluate the preliminary results using the 4+5 extensor compartmental vascularized bone graft for the treatment of stage III Kienbock's disease and to report the usefulness of this procedure. METHODS: A retrospective study was carried out on five patients who had undergone 4+5 extensor compartmental vascularized bone graft for stage III Kienbock's disease between Jan. 2005 and Aug. 2006. All patients were composed of two patients in stage IIIA and three patients in stage IIIB according to Lichtman classification. The radiographic findings were evaluated by carpal height ratio, Stahl's index, ulnar variance and scapholunate angle. The clinical outcome was assessed using the Mayo wrist score. RESULTS: The mean age of 43.4 years(range, 21-61) and the mean follow up of 23.6 months(range, 14-31) were presented. All patients were satisfied and the mean Mayo wrist score was 78(range, 70-85). Two patients showed further lunate collapse on follow-up radiographs. Four patients had no pain in the activity of daily living, one patient had a mild occasional pain. CONCLUSION: The 4+5 extensor compartmental vascularized bone graft for the surgical treatment of stage III Kienbock's disease is the effective treatment showing satisfactory clinical results, but a lunate collapse proceeds. Before this operation, the possibility of lunate collapse should be considered.

Computed Tomographic Analysis of Screw Positions in Volar Percutaneous Screw Fixation of Scaphoid Fractures

PURPOSE: We analysed the position of screws whithin the scaphoid on computed tomographic images of patients treated by volar percutaneous screw fixation for scaphoid fractures. MATERIALS AND METHODS: We reviewed 16 patients treated by volar percutaneous screw fixations for scaphoid fractures. In three (proximal, middle, distal) portions of the scaphoid, the distance from the center of the screw to the edge of the cortex and the diameter of the scaphoid were measured on the sagittal and coronal reconstructive computed tomographic images. We divided into two groups: the risk group with cortical breakage or penetration by the screw and the safe group with no cortical breakage. The position of screws was analysed and compared between two groups. RESULTS: The position of screws in the proximal scaphoid was more central than the distal scaphoid (p<0.05). The central screw placement in the distal scaphoid correlated with that in the proximal scaphoid. The average distance from the volar surface of the scaphoid tuberoisity to the entry point was 7.0 mm(5.0~8.8 mm) in risk group and 4.7 mm(1.5~7.6 mm) in safe group. It was differed significantly between risk group and safe group(p<0.05). CONCLUSION: This study suggests that volar percutaneous screw fixation for scaphoid fractures can achieve central screw placement in the proximal scaphoid. For the safe placement of the screw, a surgeon should be careful not to locate the entry point too far posteriorly on the scaphotrapezial joint.

The Effect of Tourniquet on Patellofemoral tracking during Total Knee Arthroplasty

PURPOSE: To evaluate the effect of the tourniquet on intraoperative patellar tracking and to determine how this may influence the decision to perform lateral release during primary total knee arthroplasty (TKA). MATERIALS AND METHODS: From Jan. 1998 to Feb. 1999, 126 TKAs in which patellar tracking was assesed with tourniquet inflated were chosen as a control group. From May 1999 to June 2000, a total of 221 consecutive TKAs in which patellar tracking was assessed before and after tourniquet release were selected as a study group and were placed into 1 of 3 groups: Group I (49 out of 221) were knees that tracked properly both before and after tourniquet release. Group II (150 out of 221) were knees that maltracked with the tourniquet inflated and subsequently corrected with the tourniquet deflated. Group III (22 out of 221) were knees that maltracked both before and after tourniquet release, therefore required a lateral release. The lateral release rate, patella tilt and displacement were compared among groups. RESULTS: In control group, the lateral release rate was 65.9%(83/126). The patella tilit and displacemen were 2.65+/-0.78 degree and 3.51+/-1.68 mm respectively. In study group, the lateral release rate was 10.0%(22/221). The patella tilit and displacement were 0.76+/-0.85degree and 2.96+/-1.96 mm in study group. CONCLUSION: Tourniquet application alters intraoperative patellar tracking during TKA. When contemplating lateral retinacular release, tourniquet release and reevaluation of patellar tracking should be considered.