Difficulties Encountered in Removing a Tibial Intramedullary Nail in a Healed Tibial Fracture / 대한정형외과학회잡지

PURPOSE: The authors report their experience and analyze the risk factors associated with difficulties in the removal of tibial intramedullary nails. MATERIALS AND METHODS: During the period from January 1996 to March 2001, 35 ACE(R) intramedullary nails were removed from healed tibial fractures. The authors analyzed risk factors associated with difficulties in nail removal. The five patients who had difficulties (Group I) were compared with 30 patients who had uneventful removal (Group II) in parameters of age, gender, duration of nail in situ, nail diameter, nail length, and the level of fracture. RESULTS: Younger age of patients (p=0.04) was the only significantly associated risk factors. Gender (p=0.61), the duration of time in situ (p=0.20), nail diameter (p=0.41), the length of nail (p=0.31) and the level of fracture (p=0.22) were not associated risk factors. CONCLUSION: It is suggested that patients undergoing the removal of ACE nails must be warned of possible difficulties that may be encountered.

Ulnohumeral Arthroplasty in Osteoarthritis of the Elbow / 대한정형외과학회잡지

PURPOSE: The aims of this study were to determine the effectiveness and the problems associated with ulnohumeral arthroplasty in osteoarthri-tis of the elbow. MATERIALS AND METHODS: Twelve patients with osteoarthritis of the elbow who underwent ulnohumeral arthroplasty were investigated for an average 43 months (range: 26-70 months). All patients were male and of average age 55 years. All patients had moderate pain and flexion contracture over 30 degrees preoperatively. Eight patients showed symptoms of ulnar nerve irritation. The elbows were evaluated preoperatively and final follow-up involved Mayo Elbow Performance Scoring and radiography. RESULTS: Nine patients were pain-free and three were mildly painful. The mean gain in extension was 16 degrees, in flexion 14 degrees, and in Mayo Elbow Performance Score 20 points. Symptoms of ulnar nerve irritation disappeared in 7 patients. Results were excellent in four, good in six and fair in two. Radiological recurrence of osteoarthritis was noted in two cases with follow-up over 4 years. CONCLUSION: Ulnohumeral arthroplasty is one of the effective treatment options for advanced osteoarthritis of the elbow, but long term follow-up is necessary to assess the recurrence of osteoarthritis.

Aspergillosis of the Thoracic Spine in Chronic Granulomatous Disease: A Case Report / 대한정형외과학회잡지

Chronic granulomatous disease is characterized by recurrent life-threatening infections and the formation of granulomatous lesions caused by the failure of phagocytic oxidative microcidal activity that has resulted from a defect of the oxidase system. The fungal osteomyelitis of the spine in this disease is almost always caused by Aspergillus, and its treatment is not yet established although surgical management, antifungal agents, granulocyte transfusions or combination methods have been reported. We report a patient with aspergillosis who had a long-standing pulmonary lesion which subsequently spread to the adjacent thoracic wall and spine. After decompression and drainage by costotransversectomy, the severe pain was relieved but the kyphosis increased and a paraplegia developed slowly because of resistance to the antifungal therapy and the inability to perform a bone graft. The patient died 2 months after the operation because of pulmonary complications.

Comparison of Osteosyntheses in Various Types of Porous Calcium Phosphate Compounds: An Experimental Study by Posterolateral Fusion of Rabbits' Lumbar Vertebrae / 대한척추외과학회지

PURPOSE: The purpose of the present study was to compare the osteoconduction in porous bodies made of various compositions of calcium phosphate compounds and other porous artificial bones. MATERIALS AND METHODS: Single-level posterolateral spinal fusions were performed on ninety rabbits. The animals were divided into nine groups by graft materials: autograft (positive control), implantation of HA, TCP, CPP, HA/TCP composite, TCP/CPP composite, Lubboc(R) and Calcium sulfate pellet (CSP), no-graft after decortication (negative control). Serial radiography, serum calcium and phosphorus levels were checked. All animals were sacrificed 12 weeks after surgery and the fusion masses were compared by manual palpation, uniaxial tensile strength measurement and histological evaluation. RESULTS: Autografted and CPP implanted groups showed significantly higher fusion ratio than TCP, TCP/CPP composite, and no-graft groups. Meanwhile, HA and HA/TCP groups showed no significant difference with other groups in fusion ratio. From the radiological examination, TCP and CPP groups seemed to show more rapid absorption of implant than HA group. The mean values of tensile strength of autografted and CPP group were significantly larger than those of TCP, TCP/CPP composite, and no-graft groups. The result of direct inspection and microscopic examination showed the TCP-contained implants lost their porous structure, whereas the other implants did not. On the light microscopy, both HA and CPP groups showed more abundant new bone growth into the pores than TCP-contained groups, but the pore size of CPP became larger than that of the HA, which manifested more rapid absorption of CPP in the living body. CONCLUSION: The porous CPP implant is considered to be more desirable bone graft substitute because it has satisfactory osteoconductive ablility and better biodegradation than porous HA. And the maintenance of porous structure is considered to be indispensable for osteoconduction.

Scoliosis Associated with Marfan Syndrome / 대한척추외과학회지

OBJECTIVES: To evaluate characteristics and results of treatment of scoliosis associated with Marfan syndrome METHODS: The clinical data of 57 patients diagnosed as Marfan syndrome from January 1989 to June 1999 were reviewed. Thirty one patients had major curves more than 10 degrees by Cobb's method on whole spine standing film and their curve patterns and treatment methods were analyzed. Twelve cases of Marfan scoliosis who underwent posterior instrumented fusion were compared with randomly-sampled cases with idiopathic scoliosis about flexibility, correctability and correction loss of curves. RESULTS: Scoliosis was identified in 31 of 57 patients (54.4%) and among them 15 patients had the curve more than 40 degrees. Twelve curves were double major, 10 were thoracic, and 8 were double thoracic. Seventy-five per cent of the 57 patients had congenital heart disease and 40% had lens dislocation. Twelve of 31 cases underwent posterior fusion with pedicle screw instrumentation. Marfan scoliosis (mean flexibility; 39% in thoracic, 52% in lumbar) were significantly less flexible than idiopathic scoliosis (60% in thoracic, 93% in lumbar) (P0.05). Mean correction loss in Marfan syndrome was 3.2% at the mean 4.1 year follow-up in 9 cases. CONCLUSIONS: The prevalence of scoliosis in Marfan syndrome shows positive correlation with severity of the disease. As compared to idiopathic scoliosis, the curve associated with Marfan syndrome was larger and less flexible. After posterior fusion using pedicle screw instrumentation, the correctability of Marfan curve was poorer than that of idiopathic curve, which is, however, insignificant statistically. So it was considered to be a good method to treat Marfan scoliosis.

Clinical Features of Metastatic Spine Tumor and Needs for Surgical Treatment / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the clinical features of spinal metastasis, and to evaluate what is the most appropriate treatment. SUMMARY OF LITERATURE REVIEW: Severe pain and neurological compromise induced by metastatic spine tumors deteriorates the quality of life. Surgical treatment may improve the quality of life effectively. MATERIALS AND METHODS: Between January 1995 and May 1999, we studied 61 patients diagnosed for spinal metastasis, and followed for more than 1 year or to their death. They were divided into three groups, such as surgery group, radiotherapy group, and other conservative therapy group. The results were evaluated with Turgut classification for functional status, WHO analgesics cascade for pain grading, and Frankel classification for neurological symptoms. RESULTS: Forty nine patients were followed to death. The average of survival time was 15 months, and it depends on the histology of primary tumor. In the review of treatment methods, non-operative treatment was preferred by medical oncologist in majority of cases. Eleven patients were treated surgically, and their pains and neurological symptoms were improved in varing degrees. But in case of posterior decompression alone, pain was not relieved. Surgical decompression with stabilization was effective for pain and neurological symptoms. In 50 patients, radiotherapy or other conservative therapy was applied, but results were not satisfactory. CONCLUSION: In view of the quality of life, surgical treatment should be considered in more cases of patients suffering from severe pain and neurological symptoms caused by metastatic spine tumor.

Clinical and Radiological Results of Total Knee Arthroplasty with a System of Asymmetric Tibial Tray

PURPOSE: PURPOSE of this study was to evaluate the clinical and radiological results and complications of total knee arthroplasty(TKA) using the systems including an asymmetric tibial tray and a deep trochlear-grooved femoral component. MATERIALS AND METHODS: Ninety-five total knee replacement arthroplasties(68 patients) with the implant system, which has the asymmetric tibial tray and a deep trochlear grooved femoral component were analyzed clinically and radiologically. Retrograde analysis with the Knee Society clinical rating system, roentgenographic evaluation and scoring system and the Hospital for Special Surgery(HSS) score were done. The patients were average 66 years old and the follow-up period was 23month(range, 12 month to 49 month). RESULTS: Knee score was improved from 43 points to 90 points. Function score was improved from 47 points to 85 points. HSS score was improved 57 points to 89 points. Tibio-femoral angle was improved from varus 4o to valgus 5o. In last clinic visit, there was no case which had progressive radiolucent line or above 4 points in radiolucent score except one septic loosening case. There was no case of patellofemoral complications, including patellofemoral instability, patellar fracture, patellar component failure, patellar component loosening, and patellar clunk syndrome. CONCLUSTION: The TKA in this series showed excellent clinical and radiological results and low inci- dence of patellar complication.

Reconstruction of ankle using free vascularized flap from amputated hand: A case report / 대한정형외과학회잡지

It is indispensable to cover the skin defect when bone or tendon is exposed. In case of inevitable amputation of an extremity, it is possible to harvest a free flap from the amputed limb for providing coverage of the other wound. This technique allows immediate wound coverage without the morbidity of an additional donor site. We experienced an electrical burn case with inevitahle wrist disarticulation and successfully treated soft tissue defect of ankle using free vascularized flap.

Very Long Island Pedicled Sole - fillet Flap for Below - Knee Amputation Stump Reconstruction: 2 Cases Report / 대한정형외과학회잡지

The pedicled fillet flap concept has been successfully applied in both the upper and lower extremities for the treatment of difficult wound. In cases of inevitable extremity amputation, the transfer of pedicled flap from the amputed part is possible. In such substance, it is possible to obtain the pedicled fillet flap from the amputed limb to provide stump coverage. We experienced two cases of below-knee amputation due to severe flame burn which the stump was covered with island pedicled sole-fillet flap.