Treatment of Isolated Posterior Malleolus Fracture in the Ankle / 대한정형외과학회잡지

PURPOSE: An isolated posterior malleolar fracture in the ankle is very rare. We treated eight cases of isolated posterior malleolar fracture, and describe the clinical features and outcomes of treatment. MATERIALS AND METHODS: Between from March 2008 to February 2012, eight cases of isolated posterior malleolar fracture were treated in Ilsan Paik Hospital. The mean age of patients was 30 years (11-49 years); six patients were male and five were right. Slip down (4 cases) was the most common injury mechanism. We treated four cases surgically, three cases by cast and one case by ankle brace. We could not recognize three cases of isolated posterior malleolar fracture at first. The time delay to diagnose unrecognized isolated posterior malleolar fracture was nine days, 56 days and 110 days respectively. We were able to diagnose the unrecognized isolated posterior malleolar fracture using computed tomography (two cases) and magnetic resonance imaging (one case). RESULTS: The main symptom was painful swelling. The average for articular involvement of the posterior malleolar fragment was average 21.4%, and average displacement was 1.25 mm. We treated three cases surgically using a posterior lateral approach and one case using a posterior medial approach. The average American Orthopaedic Foot and Ankle Society score was 92.5 at the last follow-up. CONCLUSION: The isolated posterior malleolar fracture is very rare and if it is neglected, persistent ankle pain can remain. Isolated posterior malleolus fracture should be included as one of the differential diagnoses after ankle trauma.

Influencia pronóstica de la edad y el tiempo de evolución de los síntomas en la mielopatía cervical espondilótica / Influência prognóstica da idade e do tempo de evolução dos sintomas na mielopatia cervical espondilótica / Prognostic influence of age and evolution time of symptoms in spondylotic cervical myelopathy

OBJETIVO: Presentamos un estudio, que trata de dilucidar la influencia de la edad y el tiempo de evolución de los síntomas, en el pronóstico tras la cirugía. MÉTODO: Estudio prospectivo de 66 pacientes, intervenidos debido a MCE, valorados (escala mJOA) pre y postoperatoriamente. Seguimiento de tres años. Se analizan las variables edad y tiempo de evolución clínica (TE), esta última se subdivide en dos grupos: larga evolución (>1 año), con 35 casos y corta evolución (≤ 1 año), con 31 casos, así como la variable de reciente agravación (RA). Esta última, si la enfermedad ha ido progresando de forma paulatina, sin grandes altibajos, se valora como NO (15 casos); si hubiese una aceleración en la progresión de la enfermedad antes de la intervención, se valora como SI (20 casos). RESULTADOS: La edad tuvo una correlación (r=-0,38) con significación P<0,01 con la situación clínica preoperatoria (r=-0,38) y posoperatoria (r=-0,30) p<0,05. No se encontró correlación entre la edad y la tasa de recuperación. El TE no presentó correlación con el estado clínico preoperatorio. Se encontró una correlación negativa entre el tiempo de evolución, estado clínico postoperatorio (r=-0,46) y el TR (r=-0,42) con una significación p<0,001. TR fue un 20% mayor en los pacientes con corta evolución clínica. Cuanto a la variable RA, se apreció una mayor afectación clínica preoperatoria, 1,45 puntos de media (mJOA) con significación p<0,05, así como peores tasas de recuperación (10%) que aquellos pacientes. En RA, aunque esta última sin significación estadística. CONCLUSIONES: La edad influye negativamente en la situación clínica preoperatoria y postoperatoria, no siendo predictiva cuanto a la capacidad de mejorar. El tiempo de evolución es un valor de pronóstico para la capacidad de mejorar, siendo su influencia negativa.

OBJETIVO: Apresentamos um estudo que visa esclarecer a influência da idade e do tempo de evolução dos sintomas no prognóstico depois da cirurgia. MÉTODO: Estudo prospectivo de 66 pacientes que sofreram intervenção devido a MCE, avaliados (escore mJOA) no pré e pós-operatório. Acompanhamento de três anos. Foram analisadas as variáveis idade e tempo de evolução clínica (TE). Esta última é subdividida em dois grupos: evolução longa (> 1 ano), com 35 casos e evolução curta (≤ 1 ano), com 31 casos, assim como a variável de agravamento recente (AR). O agravamento recente, quando a doença vem progredindo de forma paulatina, sem intercorrências importantes, é avaliado como NÃO (15 casos); nos casos de progressão da doença antes da intervenção, é avaliado como SIM (20 casos). RESULTADOS: A idade teve correlação significante com P < 0,01 no quadro clínico pré-operatório (r = -0,38) e pós-operatório, com P < 0,05 (r = -0,30). Não se encontrou correlação entre a idade e a taxa de recuperação. O TE não apresentou correlação com o estado clínico pré-operatório. Verificou-se correlação negativa entre tempo de evolução, estado clínico pós-operatório (r = -0,46) e o TR significante com P < 0,001 (r = -0,42). O TR foi 20% maior nos pacientes com evolução clínica curta. A variável AR foi maior no pré-operatório, 1,45 pontos de média (mJOA) com significância estatística de p < 0,05, além de taxas de recuperação piores (10%) do que os outros pacientes. No AR, embora sem significância estatística. CONCLUSÕES: A idade influi negativamente no quadro clínico pré e pós-operatório, não sendo preditiva da capacidade de melhora. O tempo de evolução é um valor prognóstico da capacidade de melhora, sendo que sua influência é negativa.

OBJECTIVE: We present a study that aims to clarify the influence of age and time of clinical evolution of symptoms on prognosis after surgery. METHOD: Prospective study of 66 patients who underwent intervention due to SCM, evaluated (mJOA score) before and after surgery. Three-year follow-up. The variables of age and time of clinical evolution (TE) were analyzed. The latter was subdivided into two groups: long-term evolution (> 1 year), with 35 cases and short-term evolution (≤ 1 year), with 31 cases, as well as the variable of recent worsening (RW). Recent worsening, when the disease has progressed gradually, without significant complications, is evaluated as NO (15 cases); in cases of disease progression before the intervention, it is evaluated as YES (20 cases). RESULTS: Age showed a significant correlation with P < 0.01 in preoperative clinical symptoms (r = -0.38) and postoperative symptoms, with P < 0.05 (r = -0.30). No correlation was found between age and recovery rate. TE did not show any correlation with preoperative state. A significant negative correlation was found between time of evolution, postoperative clinical state (r = -0.46) and TR , with P < 0.001 (r = -0.42). TR was 20% longer in patients with short clinical evolution. The variable RW was greater in the preoperative period, 1.45 points on average (mJOA), with statistical significance of p<0.05, and worse recovery rates (10%) than those of the other patients. In RW, though without statistical significance. CONCLUSIONS: Age has a negative influence on pre- and postoperative clinical symptoms, and is not predictive of improvement capacity. Time of evolution is a prognostic value of improvement capacity, and its influence is negative.

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Treatment of Acetabular Fractures / 대한정형외과학회잡지

Acetabular fractures are usually caused by violent external force such as car clash and commonly accompany injuries of the other parts of the body. And there has been long controversy between conservative and operative treatments. A clinical analysis was performed on the 29 patients with acetabular fractures, who had been treated at seoul National University Hospital from 1973 to 1982, mainly focussed on the result of treatment. Followings are the summary of the result. 1. Conservative treatment was done in 52% and operative treatment in 48%. 2. Mean follow-up period was 1 year and 8 months. 3. The result of treatment was good or fair in 53% of conservative treatment group comparedto 71 in operative treatment group. 4. Primary total hip replacement was done in one case of bursting fracture combined with fracture of femur neck and the result was good. 5. Superior and bursting fractures showed the worst result(poor in 83%). 6. Degenerative arthritis with or without avascular necrosis was the most common complication (45 %) and it was more common in conservative treatment group (60 vs. 29%). 7. From above results it could be said that operative treatment in acetabular fractures, if carefully done with reasonable indications, would improve the result and decrease the rate of degenerative arthritis.