Total Uncinatectomy Revisited: Revision Surgery for Persistent Radiculopathy Following Anterior Cervical Discectomy and Fusion (ACDF) / 대한정형외과학회잡지

We report on a case involving total en bloc uncinatectomy of C7 without removal of the previously inserted cage, performed on a patient with a history of previous anterior cervical discectomy and fusion without uncoforaminotomy at C5-6-7 who had persistent pain radiating to the upper extremity along with progressive weakness. Satisfactory results were achieved. This procedure should be regarded as an effective option for surgical treatment of persistent or recurrent radiculopathy caused by remaining foraminal stenosis following anterior cervical fusion, and we suggest it as a new indication for this procedure.

Computer-Assisted Spine Surgery (CASS) / 대한정형외과학회잡지

Computer-assisted spine surgery (CASS) is a new discipline involving application of computer engineering and mechanical engineering to spine surgery. The tools used most commonly include preoperative surgical simulation, intraoperative navigation, and robot-assisted surgery. Surgical simulation has been utilized for both clinical and basic research. Navigation in spine surgery has focused on guidance of screw placement, however, due to limited accuracy and high cost, its use is somewhat sparse. CASS may be combined with minimal invasive spine surgery in the near future. Further validation of clinical accuracy issues and surgical outcomes as well as cost-benefit analysis is required.

Excessive Sliding of Compression Hip Screw For the Treatment of Intertrochanteric Fracture in Elderly

PURPOSE: To analyze the cause of excessive sliding of a compression hip screw for the treatment of an intertrochanteric fracture in elderly patients. MATERIALS AND METHODS: 109 intertrochanteric fractures stabilized with a compression hip screw from January 2000 to December 2006 were analyzed. The lag screws that had slid for more than 15 mm were defined as excessive. The length and incidence of compression hip screw sliding, which were compared with the fracture type (AO classification), tip-apex distance (TAD), position of the lag screw in the femoral head, use of trochanteric stabilizing plate and displacement of lesser trochanter were analyzed. RESULTS: Fourteen out of 109 cases (13%) had slid more than 15 mm. In the AO classification, 3 out of 47 (6.4%)A1 fractures, 10 out of 59 (17%) A2 fractures, and 1 out of 3(33%) A3 fractures slid excessively. In patients with a displaced lesser trochanter fragment more than 10 mm, there were 9 cases (9/10) that slid excessively. Most of the lag screws (84 out of 109) were placed in zone 5, and 9(11%) of them had slid excessively. Five were placed in zone 2 and 4 (80%) had slid excessively. Five of the 18 with a tip-apex distance of 25 mm or more had slid excessively. CONCLUSION: In A2 fractures, the size and displacement of the lesser trochanter fragment appears to be an important factor for excessive sliding. In addition, the position of the lag screw and TAD (Tip-Apex Distance) are factors for excessive sliding.

Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator

PURPOSE: We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern. MATERIALS AND METHODS: We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern. RESULTS: Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%). CONCLUSION: The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.

Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator

PURPOSE: We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern. MATERIALS AND METHODS: We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern. RESULTS: Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%). CONCLUSION: The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.