MIPPO Technique using DCS in Comminuted Fracture of the Distal Femur / 대한정형외과학회잡지

PURPOSE: To evaluate the advantages of transarticular reconstruction and fixation by MIPPO (Minimally Invasive Percutaneous Plate Osteosynthesis) using DCS in comminuted fractures of the distal femur. MATERIALS AND METHODS: From February, 1998 to August, 2000, we experienced 23 cases of comminuted fractures of the distal femur, which were treated by MIPPO and lateral parapatellar arthrotomy in most cases. The follow up period was minimally 12 months. Clinical results were evaluated using Neer scores, radiographic results and the presence of clinical complications. RESULTS: According to the Neer scores, 18 cases (78.3%) showed satisfactory results and 5 cases (21.7%) unsatisfactory results. The average period until radiographic union was 16 weeks (range 11-20 weeks). As for alignment measured using the tibiofemoral angle, 2 cases showed valgus deformity and no posterior angulation was present over 10dgrees. As for complications, 1 case showed a leg length discrepancy of 2 cm and 5 cases showed delayed union, which showed a gap radiographically between the bone fragment at the site of the fracture, and callus formation on ultrasound, but which did not need a bone graft. The radiographic union was achieved at the final follow-up. CONCLUSIONS: In the case of comminuted fractures of the distal femur, transarticular reconstruction and fixation by the MIPPO technique using DCS could reduce complications including non-union and infection.

Operative Treatment of Traumatic Dislocation of the Knee Joint: Result of Staged Reconstruction of Cruciate Ligament

PURPOSE: To evaluate clinical result of staged treatment of traumatic dislocation of the knee joint. MATERIALS AND METHODS: This study population included 15 men and 1 women who were treated between 1996 to 2001. MCL injury was treated with primary repair/ conservative treatment and posterolateral instability was treated with primary repair /augmentation. Combined meniscal injury was treated with repair/partial meniscectomy. After 3 monthes, ACL or PCL was treated by reconstruction if needed. PCL reconstruction was performed in 7 and after 5 monthes in 3 of them ACL reconstruction was performed. In 6, only ACL reconstruction was performed. In 3, no cruciate ligament reconstruction was performed. The evaluation included range of motion, Lyaholm score, stress radiogram. RESULTS: Lysholm mean value was 82.8 and ROM 124 degrees. Complication is 1 peroneal nerve palsy and 1 arthrofibrosis. Average posterior drawer compared with contralateral limb is 5.1mm. CONCLUSION: We suggest that this staged treatment for traumatic dislocation of the knee joint reduce the frequency of complication such as arthrofibrosis and obtain stability of knee joint. Acute PCL reconstruction is necessary for complete PCL tear on MRI in multiple ligament injuries.

Surgical Treatment of the Irreducible Hohl and Moore Type 2 Proximal Tibia Fracture-Dislocation 3 Years Follow up Study: 1 Case Report

Intraarticular proximal tibia fracture and dislocation patterns, that were proposed by Hohl and Moore, are generally caused by high energy mechanism . These fracture and dislocation patterns are known to be combined with injuries of popliteal artery, peroneal nerve and cruciate ligament in many cases. We experienced a case irreducible Hohl and Moore fracture-dislocation patterns type 2, in which posterior dislocation with medially displaced entire lateral condyle that could not be reduced by closed mean for fibular head blocking the proper reduction. Additionally, popliteal artery was entrapted into the fracture site. We carried out open reduction and screw fixation via posterior approach and with fibular osteomy. We followed the patient for 3 years.

Posterior Laxity after Conservative Treatment of the Acute Injured Posterior Cruciate Ligament

PURPOSE: This study analyzed the contributing factors on posterior stability after conservative treatment for the posterior cruciate ligament(PCL) injury. MATERIALS AND METHODS: During the period from June 1996 to February 2002, 16 cases had been followed for more than 12 months after conservative treatment for acute PCL injury. We analyzed associated injury, continuity and location of PCL injury by magnetic resonance imaging(MRI) also subjective scores and serial stress radiogram. RESULTS: The average posterior displacement after conservative treatment was 4.0 mm. At last follow up, posterior drawer radiogram showed average 3.3 mm in isolated PCL injury, 4.6 mm in associated injuries. In serial posterior drawer radiogram, side to side difference was average 9.1 mm at injured time, 6.0 mm at 3 months after injury, 4.5 mm at 9 months after injury, 4.0 mm at 12 months after injury. In MRI findings, twelve cases showed interstitial tear of PCL, four cases complete disrupted, respectively and their posterior displacement was at last follow op 3.7 mm, 5.0 mm. The PCL tear location was in the proximal third in 3 cases, the middle third in 8 cases, and the distal third in 5 cases. Lysholm knee score improved from 73.3 points at 6 months after injury to 86.1 points at final follow up. Lysholm knee score was 84.6 points in patients > 5 mm posterior tibial translation, 86.1 points in patients < 5 mm posterior tibial translation. CONCLUSION: The isolated PCL injury usually heals with some residual knee laxity which increase with associated injury. we recommend to protect the injured PCL for healing period, because significant improvement was found in serial stress radiogram until 6 months after injury. We also recommend aggressive treatment of associated injury.

Posterior Cruciate Ligament Reconstruction Using Hamstring Tendon with Preservation of Posterior Cruciate Ligament Remnant

PURPOSE: The purpose of study is to evaluate the clinical results of posterior cruciate ligament (PCL) reconstruction using the quadruple hamstring tendon with preservation of the PCL remnant. SUBJECTS AND METHODS: Twenty PCL reconstructions have been performed by one surgeon. The average follow-up period were at 31 months. There were 11 isolated injuries and 9 associated injuries. The clinical outcome was assessed by preoperative and postoperative posterior displacement at stress radiograph, Lysholm knee score and complications. RESULTS: At last follow up Lysholm knee scores improved from 60 preoperatively to 92 postoperatively. The average preoperative posterior displacement at stress radiograph was 14 mm and postoperatively it was 3.2 mm. The average postoperative posterior displacement at stress radiograph was 2.6 mm in isolate injury and 3.7 mm in associated injury. The average postoperative posterior displacement at stress radiograph was 2.6 mm in case of reconstruction within three weeks and 3.7 mm in case of reconstruction after three weeks. CONCLUSION: Good stability and function of knee could be obtained by PCL reconstruction using hamstring tendon with preserving the PCL remnant and non-aggressive rehabilitation.

Operative Treatment in Acute Patellar Dislocation

PURPOSE: To analyze factors related with patellar dislocation and evaluate clinical results after early surgical treatment in acute patellar dislocation. MATERIALS AND METHODS: The study was done in 11 patients who underwent surgery due to acute patellar dislocation from February 1997 to January 2000. patients who had history of previous patella dislocation were excluded in this study. The average follow up period was 23 months. Radiographs were antero-posterior, lateral at 30 degree of flexion, and Merchant view. We looked for of patella alta, trochlear dysplasia, intraarticular loose body and measured sulcus angle, congruence angle, Q-angle. We checked the location of injured medial retinaculum and ostochondral lesions, and associated intraarticular lesions from MRI, arthrosopic and operative findings. We performed the 3 operative methods: Upon the completion of the arthroscopic evaluation, medial retinacular repair (5 cases), medial retinacular repair and lateral release(3 cases). augmented repair and plication of medial retinaculum ie, modified Madigan technique(3 cases). RESULTS: patella alta was present in 7 cases(63.6%), trochlear dysplasia(crossing sign) in 5 cases(45.5%), and increased sulcus angle in 5 cases(45.5%). one or more predisposing factors contribut-ing to patella dislocation were seen in 9 of 11 cases(81.8 %). Medial retinacular tear was present in the adductor tubercle in 5 cases and midportion(parapatellar tear) in 4 cases, and relaxed without tear in 2 cases. The clinical results showed that the average Kujala score was 91 points. The congruence angle became normal in 10 cases and patella subluxation was seen in 1 case postoperatively. CONCLUSIONS: Acute patellar dislocation was related in those cases with trochlear dysplasia and patella alta and increased sulcus angle . During the 23 months follow up preiods, Excellent clinical results were obtained with early surgical treatment.