Surgical Techniques for Percutaneous Intramedullary Fixation with Steinmann Pins for Clavicle Shaft Fractures / 대한정형외과학회잡지

PURPOSE: To report the clinical results from surgical treatment for clavicle shaft fracture by percutaneous intramedullary fixation with Steinmann pins. MATERIALS AND METHODS: Between January 2004 and June 2014, the medical records of 135 patients who underwent percutaneous intramedullary fixation with Steinmann pins were reviewed. The mean follow-up periods were 15 months. The functional results were evaluated with The Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant score. The clinical results were evaluated with the shortened length of the clavicle, length of surgical wound, operation time and Kang's criteria. RESULTS: The mean bone union period was 11.6 weeks (8–16 weeks). The mean DASH score was 11.8. The mean Constant score was 91.2. The mean shortened length of the clavicle was less than 20 mm. The mean length of surgical wound was 1.2 cm (0.7–1.5 cm). The mean operation time was 18 minutes (10–35 minutes). Using Kang's criteria, 131 out of 135 patients (97.0%) showed good results. Complications included were 3 pin migrations and 2 non-unions. CONCLUSION: Percutaneous intramedullary fixation with Steinmann pins showed good results for treating clavicle shaft fracture.

Avulsion Rupture of Flexor Digitorum Profundus in Zone 1, Diagnosed in Early Stage

Avulsion injury of the flexor digitorum profundus (FDP) tendon from the distal phalanx is considered as a rare injury. We report a patient who sustained a FDP tendon rupture insertion on her fifth finger as a result of a closed, hyperextension with no accompanying laceration or predisposing pathologic condition. Preoperative ultrasonography showed complete rupture of FDP and the gap between the tendon ends. According to the classification by Leddy and Pacter, this case is type II. The reconstruction of flexor tendon using pull-out suture and tie-over button. We are reporting a case with brief review of literatures.

Treatment of Fractures of the Distal Radius Using Variable-Angle Volar Locking Plate

PURPOSE: The purpose of this study is to evaluate outcome of variable-angle volar locking plate for treatment of distal radius fractures. MATERIALS AND METHODS: We retrospectively analyzed the results in 45 cases treated by variable-angle volar locking plate. We evaluated the clinical results according to the Mayo wrist performance scoring system and radiographic results. RESULTS: All cases had bony union. The mean Mayo wrist performance scoring system was 84.8. Between preoperative and immediate postoperative radiographic measurement, the mean radial length improved from 8.4 to 11.8 mm, radial inclination from 14.2degrees to 22.4degrees, volar tilt from -4.5degrees to 9.6degrees, and intraarticular step-off from 1.8 to 0.3 mm (p0.05). All cases showed bone union with no evidence of malunion, nonunion, or metal failure. CONCLUSION: Treatment of distal radius fractures using variable angle volar locking plate showed satisfactory outcomes. It is a good option to obtain stable fixation without significant loss of reduction.

Treatment of Olecranon Fractures with Proximal Ulna Comminution Using Locking Compression Plates

PURPOSE: The purpose of this study is to evaluate the clinical results of locking compression plate (LCP) fixation for olecranon fractures with proximal ulna comminution. MATERIALS AND METHODS: We review 10 cases of olecranon fractures with proximal ulna comminution treated with LCPs from August 2011 to August 2013. Follow-up period was from 12 months to 18 months. Mean age was 63.1 years (35-84 years). According to the Mayo classification, there were eight type IIB, and two type IIIB fractures. We used Mayo classification. Clinical evaluation was performed based on radiographic union of olecranon and measurements of range of motion at last follow-up. Disability of the arm, shoulder and hand (DASH) score and Mayo elbow performance score (MEPS) were used for evaluation of functional recovery. RESULTS: All patients had bone union. According to the MEPS, nine of ten patients had a good or excellent outcome. The mean DASH score was 18.6. All cases started postoperative range of motion (ROM) within 14 days. Elbow ROM was more than 110degrees in all cases except one. Mean radiological bony union time was 4.2 months (2.5-6.0 months) postoperatively. Complication was hardware irritation in three patients. CONCLUSION: Internal fixation using LCP for olecranon fractures with proximal ulna comminution can be a good treatment option which obtains good clinical results and enables early ROM.

Isolated Avulsion Fracture of the Lesser Tuberosity of the Humerus: A Case Report

Isolated avulsion of the lesser tuberosity of the humerus is a rare injury. The mechanism of injury is the avulsion of the lesser tuberosity from forced contractions of the subscapularis muscle when the arm is forced into an externally rotated position on shoulder abduction. Authors report a case for isolated avulsion of the lesser tuberosity of the humerus which was treated with open reduction and transosseous suture fixation, as well as a view of the literature.

Circumferential Wiring Combined with Tension Band Wiring in the Operative Treatment of Patella Fracture

PURPOSE: The purpose of this study is to evaluate the radiographic and clinical results of patella fractures using a circumferential wiring combined with tension band wiring. MATERIALS AND METHODS: Between January 2005 and June 2012, 22 (male 14, female 8) patients with patella fracture treated with circumferential wiring combined with tension band wiring were analyzed retrospectively. The mean age of patients was 51 years (range, 28 to 72 years). Controlled passive range of motion exercise was started at three weeks from the postoperative day. The patients were evaluated using radiographs, clinical examination, and Levack's scoring system. RESULTS: All fractures healed and mean time elapsed for union was 11.5 weeks (range, 10 to 14 weeks). Complete union without displacement and full range of motion was achieved in all cases. Clinical results according to Levack's scoring system were excellent in 20 cases and good in two cases. We found broken wire in one case. In this case, results of clinical evaluation after reoperation were good. CONCLUSION: Circumferential wiring combined with tension band wiring is appropriate for patella fractures.

Intra-articular Benign Fibrous Histiocytoma of the Knee: A Case Report / 대한골관절종양학회지

Benign fibrous hitiocytoma of the infrapatella fat pad is very rare. It has usually do not induced a pain or a symptom because it was located deep tissue. So it was very difficult to be diagnosed. We experienced a case of deep benign fibrous histiocytoma in a 53-year-old woman. It was diagnosed by MRI. Diagnostic arthroscopic procedure was performed and the lesion was completely resected by open excision. We report a rare case of benign fibrous hitiocytoma presenting as an intra-articular tumor in the joint causing pain and limitation of movement.

A Comparison of Clinical Outcomes after Osteochondral Autologous Transplantation & Arthroscopic Microfracture Surgery for Treating of Osteochondral Lesions of the Knee / 대한정형외과학회잡지

PURPOSE: We wanted to compare the clinical outcomes after osteochondral autologous transplantation (OAT) and arthroscopic microfracture for treating of osteochondral lesions of the knee. MATERIALS AND METHODS: We reviewed 12 cases (12 patients) of arthroscopic microfracture and 10 cases (9 patients) of OAT. The mean patient ages were 33.5 years in the microfracture group and 31.3 years in the OAT group. The mean follow-up period was 31.1 months. The mean lesion sizes were 12.9x17.4 mm in the microfracture group and 16.1x21.4 mm in the OAT group. We compared clinical results using the Tegner activity score, the Lysholm knee scoring scale, the IKDC and the VAS. MRI was used to determine the recovery of the osteochondral lesions at last follow-up. RESULTS: There was no statistically significant difference between the groups for the Tegner Activity Score. Regarding the Lysholm Knee Scoring Scale, the OAT group had a better overall score than did the microfracture group (p<0.05). Both groups had similar results for the IKDC and VAS. The MRI at the last follow-up showed cartilage recovery in 53% of the microfracture cases (compared to the surrounding cartilage) and in 96.1% of the OAT cases. CONCLUSION: Microfracture and OAT both offered good clinical results when used to treat active persons in the 3rd or 4th decades of life and who have osteochondral lesions of the knee. However, OAT led to better cartilage recovery on MRI, as well as to better functional results. Therefore, OAT is the recommended method of treatment.

Effect of Bone Marrow Cell Collection Techniques and Donor Site Locations on In-Vitro Growth of Bone Forming Cells

PURPOSE: This study evaluated the influence of bone marrow cell collection techniques and donor site locations on the in-vitro growth of bone-forming cells. METHODS: Sixty six samples of bone marrow cell collections (BMCC) or bone marrow aspirates (BMA) from 15 patients were obtained. Thirty eight samples for culture were composed of 23 BMA from 7 tibial condyles and 16 ilia, with the other 15 BMCC from the contralateral ilia. The other 28 samples were used for the analysis of alkaline phosphatase activities. After counting total cell number, mesenchymal stem cells (MSC) obtained from samples were incubated for 14 days. Alkaline phosphatase staining was used to count the number of stained colonies to show osteogenic differentiation. RESULTS: The average MSC counts of BMA from tibial condyles and ilia were 1.42x10(6) and 7.35x10(6) respectively, with 4.80x10(6) from ilial BMCC (p=0.010). MSC cultures could not be produced from tibial condyles in all 7 samples. However, 9 of 15 BMCC samples and 9 of 16 ilial BMA samples were successfully cultured (p=0.018). The average of cell counts in the successful cultures was 7.92x10(6), whereas that in the failed cultures was 2.85x10(6) (p=0.000). Multiple regression analysis showed that colony count was associated with the patient's age and total cell numbers, but not with collection methods such as BMCC or BMA (p=0.000, R=0.648, beta; age=-0.405, cell number=0.356). The discriminating formula indicated that more than 5.25x10(6) cells were needed for successful culture. CONCLUSIONS: For successful cultures in vitro and for grafts, the total number of collected bone forming cells is more important than donor sites or collection methods. For young patients, grafting of bone-marrow-derived osteoprogenitor cells is promising.

Predictability of Magerl & McCormack's Load Sharing Classification on the Metal Failure after Pedicle Screw Fixation in the Thoracolumbar Spine Fracture / 대한척추외과학회지

STUDY DESIGN: A retrograde study of metal failures at thoracolumbar spinal fractures fixed using pedicle screws. OBJECTIVES: The predictability and usefulness of the McCormack's classifications for metal failures was compared with Magerl's classifications. SUMMARY OF LITERATURE REVIEW: The load sharing classification was introduced to predict metal failure after short-segmental pedicle screw fixation by McCormack. However, its reliability is uncertain. MATERIALS AND METHODS: From July 2000 to July 2003, this study examined the plain radiographs and CT images of 31 out of 46 patients who underwent posterior stabilization using pedicle screws for thoracolumbar fractures and could be followed up at least 1 year. Fractures were classified utilizing Denis's, Magerl's, and McCormack's systems. RESULTS: As a result of analysis of relation between metal failure and classification system by Magerl or McCormack, there was no significant difference in its distribution. There was no correlation between the fixation range and metal failures in type C3 fractures, but there was a correlation between short fixation and metal failures in rotational burst fractures in short fixation. CONCLUSIONS: In order to prevent metal failures after fixing thoracolumbar spinal fractures by pedicle screws, the stability should be evaluated using Magerl's classification and McCormack's total score. In addition, in cases of type C3 fractures according to the Magerl's classification, reconstructions should be carried out with a long segment fixation or anterior supporting bone grafts, particularly when McCormack's total score is greater than 7.