Anatomical Analysis of Clavicles in Korean Adults and Compatibility of Pre-Contoured Anatomical Plates / 대한정형외과학회잡지

PURPOSE: Due to the complex anatomy of clavicles, clavicular plates are not always compatible with clavicular fractures. The purpose of this study was to analyze basic data on the anatomy of the clavicle in order to determine compatibility between clavicles of Korean adults and pre-contoured anatomical plates. MATERIALS AND METHODS: We analyzed the anatomy of 600 clavicles of 300 patients who underwent three-dimensional (3D) computed tomography of clavicles in the emergency room of Konkuk University Chungju Hospital, between July 2010 and July 2011, using Andermahr's method; in addition, the compatibility between 3D axial images of clavicles and sectional images of pre-contoured anatomical plates was also examined using Adobe Photoshop. RESULTS: The mean length of the clavicle was 146.21+/-4.98 mm, the mean width was 9.63+/-1.67 mm, and the mean thickness was 9.54+/-1.67 mm. The location of the maximum superior bow was 36.17+/-0.60 mm from the lateral end of the clavicle and the mean magnitude was 5.88+/-0.62 mm. The mean depth of medial curvature was 15.89+/-1.33 mm, and the mean depth of the lateral curvature of the clavicle was 11.73+/-1.66 mm. The compatibility between clavicles and plates was 79% as above a fair compatibility in the 50% range of clavicles and 48% as above a fair compatibility in the 60% to 70% range of clavicles. On the contrary, in application of medial and lateral plates in the 60% to 70% range of clavicles, above a fair compatibility had increased to 67%. CONCLUSION: A more adequate pre-contoured anatomical plate is required for satisfactory improvement of the compatibility of clavicles of Korean adults.

The Analysis of Postoperative Mortality after Bipolar Hemiarthroplasty for Hip Fractures in the Elderly / 대한고관절학회지

PURPOSE: This study evaluated the rate of mortality and analyzed the associated risk factors in elderly patients treated with bipolar hemiarthroplaty for the hip fractures. MATERIALS AND METHODS: Between March 1994 and March 2010, the clinical records of 246 patients(278 cases) older than 75 years of age who underwent bipolar hemiarthroplaty after hip fractures were reviewed. The mean age of the subjects was 83.7 years(75-103 years). The relationship between the postoperative one year mortality and the related factors (age, gender, type of hip fractures, the timing of surgery, the associated medical condition, ASA grade, osteoporosis, walking ability and residence type) were analyzed. The subjects were divided into the dead group and survivor group. RESULTS: The mean postoperative mortality rate within 1 year was 17.2%(48 cases). The highest mortality rate was observed at postoperative 3 months(9.7%, 27 cases), followed in order by between 4 and 6 months(5.4%, 15 cases) and 7 and 12 months(2.1%, 6 cases). The postoperative mortality rate within 1 year was affected by the timing of the operation, ASA grade, patient's walking ability, and residence type, but there were no significant difference of the other factors, such as age, gender, osteoporosis, and type of hip fractures. CONCLUSION: The ASA grade, timing of the operation, walking ability, and residence type are factors associated with the mortality rate in elderly patients with hip fractures.

Bipolar Hemiarthroplasty Using Calcar Replacement Stem for Unstable Intertrochanteric Femoral Fracture in Elderly Patients / 대한고관절학회지

PURPOSE: The purpose of this study is to evaluate the results of bipolar hemiarthroplasty using calcar replacement stem for comminuted intertrochanteric fracture in elderly patients. MATERIALS AND METHODS: Between March 1998 and March 2008, the clinical records of 79 cases who were older than 75 years of age and underwent bipolar hemiarthroplaty, using calcar replacement stem with figure of eight and cerclage wiring, were reviewed. Their mean age was 82.4 years(75-92 years) and the mean follow-up period was 68 months(24-92 months). RESULTS: The mean postoperative Harris hip score was 82.1(62-92), and preoperative walking ability was recovered in 56 cases(71%). Bony ingrowth fixation was achieved in 70 cases(89%), and fibrous stable fixation was in 9 cases(11%). Stress shields were revealed in 21 cases(27%). Nonunion of trochanter was found in 3 cases(4%), and wire fixation breakages were in 3 cases after bony union. The mean duration of bony union was 16.3 weeks(12-38 weeks). Aseptic loosening was observed in 1 case and protrusio acetabuli were in 2 cases. CONCLUSION: The result of clinical and radiological evaluations of bipolar hemiarthroplasty, using calcar replacement stem with figure of eight and cerclage wiring, were satisfactory in elderly patients with comminuted intertrochanteric fracture.