Arthroscopic Treatment of Osseous Abnormalities as a Cause of Femoroacetabular Impingement : Preliminary Clinical Results / 대한정형외과학회잡지

PURPOSE: To report the preliminary clinical results for arthroscopic treatment of osseous abnormalities as a cause of femoroacetabular impingement (FAI). MATERIALS AND METHODS: We evaluated 26 patients diagnosed with FAI who were treated by arthroscopic debridement of the labrum, spur resection, and bump resection from March 2004 to March 2005. Osseous abnormalities of FAI were evaluated for the presence or absence of asphericity, pistol grip deformity, coxa vara, coxa valga, retroversion of the acetabulum, and protrusion of acetabulum were present or not. We evaluated the clinical manifestations based on patient satisfaction, sequential JOA pain scores and ranges of motion of the hips. RESULTS: 24 patients were satisfied postoperatively. The average JOA pain score preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months, were 0.85, 0.71, 1.50, 1.71, and 1.86, respectively. At 2 weeks preoperatively, the clinical symptoms were aggravated and 6 months postoperatively, the clinical symptoms were improved. 11 patients could not take a cross-legged position preoperatively: but 10 of the 11 patients could take a cross-legged position postoperatively. CONCLUSION: Preliminary clinical results for arthroscopic treatment of osseous abnormalities were satisfactory. We need to perform a follow-up study of the clinical results about the early detection of which findings and decompression of which osseous abnormalities will prevent or delay the progression of osteoarthritis through mid and long-term follow up.

A Comparison of Closed Reduction and Open Reduction in Children with Fracture of Lateral Humeral Condyle / 대한정형외과학회잡지

PURPOSE: The fracture of humeral lateral condyle in children was classified and the complications and results were analyzed according to the treatment modality and the types of fracture. MATERIALS AND METHODS: 92 patients who could be followed up one year or more, and were treated for a humeral lateral condyle fracture from May 1995 to May 2001 were studied. 66 cases were male, 26 cases were female, and 79 cases were under 9 years of age. The Milch stage I encountered in 12 cases, and II in 80 cases. Jacob stage I were encountered in 15 cases, stage II in 59 and stage III in 18 cases. Conservative treatment was performed in 9 cases and surgery was performed in 83 cases. A closed reduction and internal fixation with K-wire was performed in 18 cases, and an open reduction and internal fixation was performed in 65 cases. RESULTS: The change in the carrying angle was not clinically significant except for 7 cases, with a cubitus varus and cubitus valgus deformity. The change in the carrying angle showed an average -1.3 (from +7 to -18). The results according to the Hardacre criteria were `excellent' in 46 cases, `good' in 41 and `poor' in 5. Regarding the complications, bony spur formation was encountered in 8 cases, overgrowth of the lateral condyle and cubitus varus in 4, cubitus valgus in 3, avascular osteonecrosis in 3, premature epiphyseal fusion in 2, nonunion in 2, delayed union in 1, fish-tail deformity in 1, local infection in 5, range of motion limitation in 2 and transient radial nerve palsy in 1 case. CONCLUSION: Humeral lateral condylar fractures have a high rate of complications and clincally significant complication appeared mainly in stage II and III. This suggests that more a careful dissection of the soft tissue and anatomical reduction in Jakob stage III is required in cases of an open reduction.

Biomechanical and Histological Effects of Different Regimens of Immobilzation after Operative Treatment in a Ruptured Rabbit Achilles Tendon / 대한정형외과학회잡지

PURPOSE: To evaluate the effects of the different regimens of immobilization after surgery in a rabbit model. MATERIALS AND METHODS: The study was performed on the right Achilles tendon of 30 rabbits. Modified Kessler method was used to suture the transected tendon. Rabbits were divided into three groups, Group I (n=10) underwent long leg cast with equinus position for 6 weeks, Group II (n=10) underwent weekly cast correction to full dorsiflexion from 1 week after surgery, and Group III (n=10) underwent daily correction of equinous position with external fixator from 1 week after surgery. The contralateral Achilles tendon served as an unoperated control. And three groups were compared at 6 weeks after surgery. RESULTS: The maximal load at rupture (N) was 55.50, 97.46, 140.27, 180.98 for group I, II, III and control respectively. The strain was 0.44, 0.49, 0.74, 0.67. The stiffness (N/mm) was 9.63, 17.87, 19.01, 23.33. The absorbed energy to rupture (J) was 12.23, 23.98, 51.20, 60.78. Values among groups were significantly different considering the maximal load, strain, stiffness, and absorbed energy to rupture (p<0.05). Histological finding was revealed more mature restoration and more parallel arrangement of fiber bundles in the group II, and especially group III. Achilles tendon rupture, Maximal load, Strain, Stiffness, Tensile loading. CONCLUSION: Tensile loading of the healing tendon by postoperative continuous correction leads to changes in more similar to the normal Achilles tendon, biomechanically and historically.

Modified Phemister Technique with Mersilene Tape Augmentation in the Acute Acromioclavicular Joint Dislocation

PURPOSE: To find out the consequences of the surgical treatment of acromioclavicular joint dislocation, using modified Phemister technique with Mersilene tape augmentation. MATERIALS AND METHODS: We chose 26 patients who were able to follow up 1 year or more among the patients who were diagnosed as acromioclavicular joint dislocation in our hospital through February 2001 to March 2003 and took modified Phemister surgery with Mersilene tape augmentation. Patients with clavicle fracture were excluded. Evaluation of the surgical results was done with the condition or pain, function, range of motion by using Imatani evaluation system, and preoperative, postoperative and last follow up radiographs. RESULTS: Most of the cases showed satisfactory result. Clinical evaluations were 16 excellent (62%), 10 good (38%), radiological evaluations were 14 excellent (54%), 10 good (38%), 2 fair (8%), and no poor group. On the final follow up six cases showed vertical translation, but none had clinical symptoms. Seven cases showed a little inflammation at where pin were inserted, but after the removal of the pin, the inflammation was gone. CONCLUSION: The modified Phemister surgery for acromioclavicle dislocation is simple, but we can obtain strong fixation, and there is no burden of the removal of the metal plate, or complication of re- dislocation after the removal of the pin, so it is thought as a very effective surgery.