Complications of Femoral Pertrochanteric Fractures Treated with Proximal Femoral Nail (PFN)

PURPOSE: We analyzed the complications of femoral pertrochanteric fractures treated with proximal femoral nail (PFN®) to reduce the its complications. MATERIALS AND METHODS: We evaluated the complications among 198 patients who were treated with PFN® from June 2001 to August 2005 in our hospital. RESULTS: The complications were presented in 28 cases (14.1%). Cut-out of lag screw was in 1 case, cut-out of lag screw and antirotation screw were in 3 cases, cut-out of antirotation screw in 3 cases, of these femoral head fracture was in 1 case. Femoral neck fracture in 1 case, Osteonecrosis of femoral head in 1 case, cortical fracture during the insertion of distal interlocking screw in 1 case, breakage of drill bit intraoperatively in 1 case, fibrous union in 2 case, thigh skin irritation due to screw back-out in 3 cases, periprosthetic fractures in 2 cases, varus collapse more than 10 degrees in 4 cases, superficial and deep infections in 3 cases, breakage of nail in 1 case, varus collapse after PFN removal in 1 case, persistent thigh pain in 1 case. Of all these cases, 9 cases (4.5%) were required reoperation with general or spinal anesthesia. Complications related with screws or fracture reduction were 19 cases (9.6%) and, of these, 17 cases (89.5%) showed increased TAD (tip apex distance) or nonanatomical reduction. CONCLUSION: To reduce the complications of PFN®, we need to exact surgical technique and anatomical reduction and consider the modification of implant design to prevent of cut-out of screws.

Comparison of the Antibiotic Release Kinetics from the Implant Coated with Antibiotic-impregnated Polymers / 대한정형외과연구학회지

PURPOSE: To compare the antibiotic release kinetics of the implant coated with antibiotic-impregnated polymers MATERIALS AND METHODS: Authors used polylactic acid (PLA) and polylactic-co-glycolic acid (PLGA) as the biodegradable carriers, gentamicin sulfate as the antibiotic and Steinmann pin as the implant. Ten Steinmann pins were coated with gentamicin of each 10, 20 and 30% mixture of PLA or PLGA for the elution kinetics study. In the elution study, total 60 coated implants were incubated in 10 mL of phosphate buffered saline (PBS) at 37 delta C and sampled at 6 hrs, 1, 3, 6, 9, 12, 15, 20, and 25 days. Assays were performed with fluorescence polarization immunoassay. Statistical analysis was done with SAS release 2.01. RESULTS: Released concentration of GM decreased with time. Minimum inhibitory concentration was maintained until 6th day on PLA 10% subgroup, 9th day in the 20 and 30% subgroups, until 6th day on PLGA 20% subgroup, and 3rd day in the 10 and 30% subgroups. Released concentrations were significantly higher in all PLA subgroups than in PLGA as a parameter of sampled time (all p<0.05). There was no statistical difference between PLA 20 and 30% subgroup after 12th sampled day (p=0.2636). CONCLUSION: PLA-GM group showed higher effective concentration for longer time than PLGA-GM group. 20 and 30% subgroups of PLA-GM showed prolonged maintenance of minimum inhibitory concentration compared with 10% subgroup, but there was no difference between the two groups.

Structural Allograft for Femoral Deficiency in Revision Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: We investigated the results and the effectiveness of structural allografts, which were obtained from a donated cadaver for femoral deficiency in revision total hip arthroplasty. MATERIALS AND METHODS: We reviewed 27 patients who received a structural allograft for femoral deficiency in revision total hip arthroplasty with a minimum follow-up of 2 years. All allografts were fresh frozen bone obtained from donated cadavers. Whole proximal femur was used in 3 patients and strut or cortical onlay graft in the others. The results were evaluated by using Harris hip scores and by the presence of complications, clinically and stability of stem, osteolysis, radiolucent line, and by the radiographic union of the allograft. RESULTS: The average Harris hip score improved from 40.1 preoperatively to 86.9 postoperatively, and the stem showed bony stability in 18 patients, fibrous stability in 8 patients, and instability in 1 patient due to the recurrence of infection. Radiologically, osteolysis was observed in 4 patients (14.8%), radiolucent line over 2 mm in 1 patient, and union of allografts in 25 patients (92.6%) that showed stable stem. The average union time was 7.5 months. Nonunion of allografts were observed in 2 patients revised with a cancellous bone autograft. Complications were infection in 1 patient, dislocation in 2 patients, and heterotopic ossification in 1 patient. CONCLUSIONS: Structural allografts obtained from cadaveric donor were used for large femoral deficiency in revision total hip arthroplasty. Our results show that satisfactory union and can successfully restore the bone stock for further surgery.

Selective Ultrasonography and Screening of Neonatal Hip / 대한정형외과학회잡지

PURPOSE: The purpose of this paper was to evaluate the results and usefulness of neonatal hip screening using selective sonography prospectively. MATERIALS AND METHODS: 3,954 neonates were clinically examined and hip sonographic examination, using Modified Graf method, was performed selectively in all neonates who had the sign of DDH or some of 'high risk' characteristics. RESULTS: Sonographic examination was performed in 387 neonates (9.8%) . Nine neonates (0.23%) with positive Ortolani test, 14 (0.35%) with subluxatable or lax joints, 110 (2.78%) among 363 neonates (9.1%) with some of 'high risk' characteristics had follow-up sonographic examination because one or both hips didn't belong to type Ia of Graf classification. Graf type, angle a, angle b and head coverage percentage of hips, which had follow-up sonographic examination, were not significantly different enough to be used as a parameter to classify the degree of stability of hip by clinical examination. Additional dynamic sonography were helpful. Treatment were applied in 16 babies (0.4%) including 8 among 9 of positive Ortolani test, 3 among 14 of subluxatable hips and 5 among 110 with sonographically immature or dysplastic hips. CONCLUSION: We detected DDH in neonatal periods by hip screening, and selective sonography was helpful in detecting sonographically unstable hips or dysplastic hips which were clinically stable.

Piriformis Syndrome: A Case Report / 대한정형외과학회잡지

The most common cause of pain in the distribution of sciatic nerve is a herniated lumbar disc, Spinal stenosis, intrapelvic masses, and diabetic neuropathy may also produce scitica-like symptom. Infrequently, Piriformis syndrome is a rare disease causing sciatica produced by entrapment of sciatic nerve by the piriformis muscle as it passes through the sciatic notch. Recently we experienced a case of piriformis syndrome to be successfully treated by exploration of sciatic nerve and sectioning of fibrous band between piriformis muscle and gluteus maximus muscle. We would describe the clinical feature of a piriformis syndrome, and review other literatures.

Scleral Buckle which Use Intraorbital Balloon in Retinal Detachment

We performed temporary scleral buckles to treat the rhegmatogenous retinal detachment without traction by using intraorbtal balloon. Four eyes of four patients were operated from July 1994 to January 1995 and followed for at least 6 months. Balloon was inserted into the parabular space and left for one week. Cryopexy- or laser-induced adhesions were needed to make the attachments permanent. In all patients, retina reattached successfully without reopening of retinal break after the removal of the balloon. We suggest that intraorbital ballooning is a good choice of primary procedure for the retinal detachment with a single retinal break or group of breaks close together, because this is simple and inexpensive.