The Pattern of Use of Oral NSAIDs with or without Co-prescription of Gastroprotective Agent for Arthritic Knee by Korean Practitioners

PURPOSE: The aim of this study was to describe the patterns of use of non-steroidal anti-inflammatory drugs (NSAIDs) for arthritic knees in clinical practice, particularly focusing on the co-prescription of gastroprotective agents for patients with risk factors for adverse gastrointestinal (GI) events. MATERIALS AND METHODS: Each cross-sectional cohort was a group of outpatients visiting 111 physicians who had prescribed NSAIDs for the patients' arthritic knees for more than three consecutive months. A self-administered questionnaire was completed by each patient and physician. RESULTS: Nine hundred and forty five patients (48%) of the whole 1,960 patients belonged to the group with a high or very high risk for NSAID-induced gastropathy determined by northern California Health Maintenance Organization guidelines. Overall, only less than half of the patients were given co-prescription of gastroprotective agents, regardless of the presence or absence of GI symptoms and irrespective of the level of risk for NSAID-induced gastropathy. CONCLUSIONS: The physician prescribing NSAIDs for arthritic knees should monitor any GI symptoms and the patient monitor anylevel for NSAIDinduced gastropathy, and be willing to add gastroprotective agents as necessary in order to prevent serious adverse GI events.

The Prevalence of Bacterial Nasal Colonization in Patients Undergoing Primary Total Knee Arthroplasty

PURPOSE: The objective of the current study was to investigate the prevalence of bacterial nasal colonization in patients who are undergoing primary total knee arthroplasty and to determine whether the prevalence affects the incidence of deep surgical site infections. MATERIALS AND METHODS: Of the 488 consecutive patients (784 knees) who had been screened for bacterial nasal colonization using nasal swab cultures before elective total knee arthroplasties, 434 patients (88.9%) were available for review at one year postoperatively. We assessed the overall rate of deep surgical site infections in the patients with nasal carriage of bacteria (group I) and in those patients without any bacterial nasal colonization (group II), respectively. RESULTS: Of the 434 patients, 69 (15.9%) had nasal carriage of bacteria. There was 1 infection (0.9%) among 113 knees of 69 patients in group I and 10 infections (1.7%) among 591 knees of 365 patients in group II. Those differences were not statistically significant. CONCLUSION: The prevalence of bacterial nasal colonization in patients undergoing primary total knee arthroplasty was 15.9% and the preoperative nasal carriage of bacteria did not affect the rate of deep surgical site infections.

Development of an Adequate Propofol Sedation Model in Elderly Patients for Elective Surgery under Regional Anesthesia

BACKGROUND: Propofol, an ultrashort-acting anesthetic agent, is being increasingly used for sedation during regional anesthesia. The goal of this study was to characterize the pharmacodynamic relation between the effect site concentration of propofol and the occurrence of loss of consciousness (LOC) and apnea in elderly patients undergoing regional anesthesia. METHODS: Twenty patients aged 65 years or older presenting for elective surgery requiring regional anesthesia were enrolled. After performing spinal anesthesia, the target effect site concentration of propofol was set at 1.0 microg/mL. Effect site concentration was increased by 0.2 or 0.3 microg/mL until LOC and apnea were observed. LOC was determined by the loss of response to verbal command ("open your eyes") and apnea as the loss of spontaneous breathing for 20 seconds. The pharmacodynamic relation between effect site concentrations of propofol and LOC or apnea was characterized by population analysis using nonlinear mixed effects model. Approximate entropy (ApEn) as a surrogate measure of central nervous effect of propofol was calculated from raw electroencephalogram, retrospectively. The correlation between effect site concentration of propofol and ApEn was tested. RESULTS: The estimates (standard error) of Ce50 for LOC and apnea (the effect site concentration of propofol associated with 50% probability of LOC and apnea) were 1.74 (0.09) and 2.35 (0.11) microg/mL, respectively. The Spearman correlation coefficient between effect site concentration of propofol and ApEn was -0.8164 (p<0.0001). CONCLUSION: These results provide an adequate guidance for sedation in elderly patients for elective surgery under regional anesthesia.

Preoperative Risk Factors for Deep Infection Following Total Knee Replacements

PURPOSE: The aim of this study was to investigate the overall rate of deep infection and the risk factors for infection after primary total knee arhroplasties. MATERIALS AND METHODS: We conducted a retrospective case-control study of 229 patients (376 knees) who underwent total knee replacement (TKR) between January 2006 and June 2007 and who were followed up for more than one year. The risk factors for deep infection were determined via univariate analyses. RESULTS: The overall rate for developing infection was 1.9% (7 of 376). The risk factors were an operating theatre other than the main room (odds ratio=33.2, 95% confidence interval=1.9, 583.6) and a preoperative hemoglobin level lower than 12 mg% (odds ratio=4.3, 95% confidence interval=1.9, 9.4). CONCLUSION: The deep infection rates after TKRs might vary depending on the preoperative level of hemoglobin and the operating-room environment. Successful strategies to overcome the host and environmental risk factors are needed with the goal of preventing infection of the prosthesis.

Development of Korean Academy of Medical Sciences Guideline for Rating Physical Disability of Upper Extremity

While the lower extremities support the weight and move the body, the upper extremities are essential for the activities of daily living, which require many detailed movements. Therefore, a disability of the upper extremity function should include a limitation of all motions of the joints and sensory loss, which affects the activities. In this study, disabilities of the upper extremities were evaluated according to the following conditions: 1) amputation, 2) joint contracture, 3) diseases of upper extremity, 4) weakness, 5) sensory loss of the finger tips, and 6) vascular and lymphatic diseases. The order of 1) to 6) is the order of major disability and there is no need to evaluate a lower order disability when a higher order one exists in the same joint or a part of the upper extremity. However, some disabilities can be either added or substituted when there are special contributions from multiple disabilities. An upper extremity disability should be evaluated after the completion of treatment and full adaptation when further functional changes are not expected. The dominance of the right or left hand before the disability should not be considered when there is a higher rate of disability.

Development of Korean Academy of Medical Sciences Guideline Rating the Physical Impairment: Lower Extremities

Lower Extremities Committee of Korean Academy of Medical Sciences Guideline for Impairment Rating develops new guidelines which are based on McBride method, American Medical Association Guides, Disability evaluation by The Korean Orthopaedic Association, The Korean Neurosurgery Society, and Korean Academy of Rehabilitation Medicine. The committee analyzed and discussed to create an ideal method practical in Korea. Our committee endeavors to develop new methods which are easy to use, but are suitable for professional use and also independent from the examinee's intentions. The lower extremities are evaluated on the basis of anatomic change, functional change, and diagnosis based evaluation. Nine methods are used to assess the lower extremities. Anatomic assessment includes leg length discrepancy, ankylosis, amputation, skin loss, peripheral nerve injury, and vascular disease. In functional assessment, range of motion and muscle strength are included. Diagnosis-based assessments are used to evaluate impairment caused by specific fractures, deformities, ligament instability, meniscectomies, post-traumatic arthritis, fusion of the foot, and lower extremity joint replacements.

The Treatment of Posterolateral Malleolar Fractures using Percutaneous Reduction Technique

PURPOSE: To evaluate the usefullness of the percutaneous reduction technique with K-wire that could reduce the displaced posterolateral fracture fragment which persisted even after an anatomical reduction of the lateral malleolar fracture. MATERIALS AND METHODS: From January 2004 to December 2006, we reviewed 72 patients who underwent surgical treatment for their trimalleolar fractures. We estimated the clinical and radiological results of 5 cases treated by percutaneous reduction technique with K-wire when more than the distal tibial articular step-off was left after reduction of the lateral malleolar fracture. The method of reduction starts with temporary fixation of lateral malleolar fracture followed by checking ankle radiographic image to confirm the accuracy of reduction. In case of incomplete reduction of the posterior fragment, a K-wire is inserted into the posterior fragment and pushed downward to the ankle joint level, and then lag screws were inserted. RESULTS: The average articular involvement by the posterolateral fracture fragment was 30.2%. The average step-off after reduction of the lateral malleolar fracture was 3.7 mm. At the final follow up, step-off was less than 2 mm in all cases. In clinical results by Baird and Jackson score, 3 out of 5 cases were excellent, other 2 were good. CONCLUSION: Percutaneous reduction technique for posterolateral fragment using the K-wire is relatively easy. This technique may be useful when the posterolateral fragment is large (more the 25% of articular surface) and not severely comminuted.

Pain in Patients Evaluated in Outpatient Orthopaedic Clinics

PURPOSE: We performed this study to assess pain in patients seen in member outpatient orthopaedic clinics of the Korean Knee Society (KKS). MATERIALS AND METHODS: We organized a committee for the study of knee joint pain. The committee designed a questionnaire form consisting of 11 items related to pain. One hundred thirty-five regular members of the KKS asked all patients visiting their respective outpatient clinics during May 2007 to complete the questionnaire form. Although 12,418 patients agreed to fill out the questionnaire form, we only analyzed the questionnaire forms of 9,578 patients who answered completely. RESULTS: 1. Approximately 85% of patients visiting outpatient orthopaedic clinics complained of pain. 2. The average degree of pain was more than moderate, and 72% of patients simply desired to be free of pain. 3. Seventeen percent of patients thought their physicians underestimated their pain. 4. Regarding agreement in the assessment of pain between physicians and patients, there was low level of agreement by numeric rating scale, but a high level of agreement based on a mild/moderate/severe grading scale. 5. Approximately one-third (36.2%) of patients had used additional treatments for pain relief on top of their prescribed medications. CONCLUSION: Eighty-five percent of patients complained of pain, and two-thirds of them were primarily focused on its relief in their visit to the outpatient clinic. Hence, we should heed pain management itself as an important goal in treating orthopaedic patients.

3.5 mm T-shaped LCP (Locking Compression Plate) Fixation for Unstable Distal Clavicular Fractures

PURPOSE: To review the clinical and radiological results after an open reduction and internal fixation with a T-shaped LCP for unstable distal clavicle fractures. MATERIALS AND METHODS: From February 2005 to June 2006, ten patients with distal clavicle Neer type II fractures were treated with an open reduction and internal fixation with a T-shaped LCP. Bony union was identified by plain radiography. The clinical results were analyzed according to the UCLA scoring system. RESULTS: The mean time to fracture union was 9weeks and union was achieved in all cases. The mean UCLA score was 33.4 (30-35); excellent in 8 cases and good in 2 cases. In one case, loosening of one distal screw was occured and mild AC joint subluxation was observed in another case. CONCLUSION: 3.5 mm T-shaped LCP fixation is a useful technique for treating unstable distal clavicle fractures. This procedure provide stable fixation with no further AC joint injury.

The Effect of Patellar Position on the Flexion Gap in Total Knee Arthroplasty

PURPOSE: The aim of this study was to investigate the relationship between eversion or reduction of patella and the heights of the extension or flexion gaps. MATERIALS AND METHODS: Measurements of the heights of the extension and flexion gaps were obtained during 32 primary posterior-stabilized total knee arthroplasties in 25 osteoarthritic patients. A tensor device was introduced after femoral and tibial bony resections while putting the knees flat on the operating table to measure the extension gaps in the medial and lateral compartments, respectively. The knee was flexed 95 degrees, and the tensor was introduced to measure the flexion gaps in the same manner. A calibrated torque wrench permitted the application of the force of about 113.4N.cm both in extension and in flexion in right knee, and of about 152.4N.cm both in extension and in flexion in left knee. RESULTS: The average height of the extension gap with everted patella was 20.9+/-2.6mm medially and 23.6+/-2.5 mm laterally, respectively. The average height of the extension gap with reduced patella was 21.0+/-2.6mm medially and 23.7+/-2.4mm laterally, respectively. The average height of the flexion gap with everted patella was 20.7+/-2.5mm medially and 23.2+/-2.8mm laterally, respectively. The average height of the flexion gap with reduced patella was 22.1+/-2.3mm medially and 24.2+/-2.8mm laterally, respectively. After reducing the patella, the flexion gap height increased an average 1.4+/-1.1(range: 0~4)mm and 1.0+/-1.2(range: -1~3)mm in the medial and lateral compartments, respectively. CONCLUSION: The height of flexion gap would be increased by reducing the patella from everted position in posterior- stabilized total knee arthroplasty for the patient with good preoperative flexion. The flexion gap must be observed not with everted patella but with reduced patella to determine whether it appears symmetric and balanced.

Radiologic Evaluation of Change of Ankle Joint after Total Knee Arthroplasty / 대한족부족관절학회지

PURPOSE: To evaluate the incidence and describe radiologic pattern of ankle arthritis following change of mechanical loading axis by total knee arthroplasty. MATERIALS AND METHODS: We reviewed radiographs of 419 cases, 243 patients underwent total knee arthroplasy from January 2002 to October 2006 retrospectively. We described radiologic parameters around the ankle joint and measured the amount of change of knee varus or valgus angle by comparing preoperative and postoperative anteroposterior standing lower extremities AP X-rays. We divided cases into two groups, one with radiologically arthritic change of the ankle joint and the other one without any radiologic change after surgery. We compared two groups in each parameters and analyzed statistically (SPSS v13.0). RESULTS: Three hundred eighty one cases were divided into varus group and 38 cases in valgus group. 125 cases were divided into ankle arthritic change-positive subgroup among the varus group and 251 cases were in negative subgroup. The amount of varus angle correction by total knee arthroplasty showed significant difference between two subgroups. There was no significant difference in each parameters between subgroups within 38 valgus cases. CONCLUSION: Ankle arthritis can be aggravated after total knee arthroplasty because of the change of mechanical loading axis onto the ankle joint. Therefore it may be needed to evaluate symptoms and function of ankle joints before performing total knee arthroplasties especially in patients with huge varus deformities of knee joints.

The Effect of Lateral Retinacular Peeling in Total Knee Arthroplasty

PURPOSE: The aim of the present study was to investigate if a lateral retinacular peeling helped decrease the amount of lateral patellar tilt in total knee arthroplasty (TKA). MATERIALS AND METHODS: The lateral tilt angles were measured in tangential radiographs made preoperatively and postoperatively, with the knee in 100 degrees of flexion, in an earlier series of 38 TKAs(Group 1) and a series of 53 TKAs (Group 2) that included lateral retinacular peel and partial facetectomy. RESULTS: The mean preoperative patellar tilt angle was 9.1+/-4.5 degrees in the group 1 and 9.5+/-5.2 degrees in the group 2. The mean postoperative patellar tilt angle was 12.8 +/-6.2 and 11.0+/-7.1 degrees, respectively. The implant tilt angle was 6.3+/-7.3 and 5.5+/-6.1 degrees, respectively. The differences between two groups were not statistically significant. CONCLUSION: The patella would tilt laterally following total knee arthroplasty. A lateral retinacular peeling had no discernible effect on the postoperative lateral tilt of the resurfaced patella.

Extracorporeal Shock Wave Therapy for Calcific Tendinitis of the Shoulder / 대한정형외과학회잡지

PURPOSE: To evaluate whether Extracorporeal Shock Wave Therapy (ESWT) is an effective treatment without side effects for chronically painful calcifying tendinitis. MATERIALS AND METHODS: Study subjects were 72 patients (17 males and 55 females) aged 37-64 years, with a mean of 48, showing chronic, symptomatic, calcifying tendinitis of the shoulder refractory to other conventional conservative therapies. Calcifications were type I or type II according to the classification of Gartner, and with a minimum diameter of 10 mm. Patients with type 3 calcific tendinitis were excluded, because this type has a strong tendency to spontaneous resolution. Extracorporeal shock wave therapy comprised one or two treatments, each consisting of 800 shocks, with a frequency of 120 impulse per minute and the energy density of 0.14 mJ/mm2. We assessed the presence and size of calcified deposits at 1, 3, 6 and 12 months by conventional radiography. All patients also underwent clinical examination, and the Constant (and Murley) score and pain were calculated. The intensity of pain was measured with the visual analogue scale (VAS) from 0 to 10 points, where 0 represents the absence of pain and 10 unbearable pain. RESULTS: One month after the treatment, complete resorption of the calcium deposits was observed in 19 patients (26%), partial resorption was observed in 26 patients (36%), and no modification in the calcium deposits was observed in 27 patients (38%). At six months the complete disappearance of the calcium deposits was noted in 42 patients (68%), but in the 10 patients (14%), calcium deposit appeared unchanged. This result is remained unvaried after 6 month follow-up. Using the Constant and Murley score, this study showed a significant decrease in pain and a significant increase in shoulder function (p<0.001). At six months, 76% of the patients presented satisfactory functional result. About 15% reported a subjective and objective recovery, and only 6 patients (8%), classified as poor result but in our series no differences were found between results at 6 month and 12 month follow-up. At 12 month follow-up there were differences in the Constant score between treated shoulder and contralateral side, respectively 77.6 (59-91) and 87.2 (74-96), but not significant. There were no side effects. CONCLUSION: ESWT is an effective treatment without side effects and an alternative therapy for chronically painful calcifying tendinitis of the shoulder refractory to conventional therapies.

Nonsurgical Treatment of Osteoarthritis

Osteoarthritis (OA) is the most common cause of localized or generalized joint pain in adults. OA is a condition that represents a complex of interactive degradative and reparative processes in the cartilage and bone with secondary inflammatory changes, particularly in the synovium. Although there is no known cure for OA, the treatment designed for the individual patients can reduce pain, maintain joint mobility, and limit the functional impairment. Guidelines for the treatment of OA include patient education and physical and occupational therapy. Weight loss has been shown to slow the progression of disease and to relieve symptoms in obese patients with OA of the knee. While low-impact exercise is beneficial, the adverse effects of high-impact and high-intensity activitiesy on the aggravation of OA have been documented. Most drug therapies with drugs are targeted to specific symptomsatic response. It is certainly worthwhile to initiate a trial of acetaminophen, known to be beneficial in OA patients with mild to moderate pain, on the basis of the risk-to-benefit ratio and cost. However, previous studies suggest that nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with a better efficacy. The COX-2-specific inhibitors appear to be better tolerated, with a lower incidence of GI side effects, than comparator nonselective NSAIDs. However, the potential cardiovascular thrombotic events of these medications are considerable in the patients with hypertension or coronary artery disease. Although a number of agents are on the horizon, including glucosamine, chondroitin, diacerein, S-Adenosyl-LMethionine, and hyaluronan, no agent has been shown to have a disease-modifying OA drug (DMOAD) effect at this time.

The Effect of Intraoperative Tourniquet Deflation in Total Knee Arthroplasty

PURPOSE: The aim of this study was to evaluate the effect of tourniquet deflation for hemostasis on postoperative blood loss in total knee arthroplasty. MATERIALS AND METHODS: The tourniquet was deflated intraoperatively before prosthesis insertion, hemostasis was established, and the tourniquet was reinflated before wound closure for 41 patients(Group I) and the tourniquet was not released until after the wound was closed in 46 patients(Group II). The postoperative blood loss was determined by measuring it in the suction drainage during first 24 hours and total blood loss was calculated from the decline in hematocrit. RESULTS: The measured blood loss during first 24 hours for group I averaged 1096 ml, while that for Group II averaged 1036 ml. Total blood loss including hidden blood loss for group I averaged 1639 ml, while that for Group II averaged 1593 ml. CONCLUSION: Tourniquet deflation for hemostasis in primary total knee arthroplasty is not an effective means of reducing postoperative blood loss.

Effect of Smoking on Long Bone Shaft Fracture Healing / 대한정형외과학회잡지

PURPOSE: To evaluate the effect of smoking on the union time of the long bone shaft fractures. MATERIALS AND METHODS: We retrospectively analysed eighty-four patients with a long bone shaft fracture who were treated during the last four years. Patients with polytrauma, severe comminuted fracture, open fracture over grade III, ESRD or other internal diseases were excluded. In this study we separated the groups into smoking and non-smoking groups. Also we observed whether there was any significant difference in the union time and other factors such as the age, sex, fracture location and configuration, and method of fixation by using medical records and radiographs. RESULTS: A significant difference in union time was found between the smoking group and the non-smoking group (p=0.041), especially in the tibia. The average union time was 12.54+/-1.62 weeks in the smoking group and 11.53+/-2.59 weeks in non-smoking group. There were three non-union cases in the smoking group and one in the non-smoking group. Other factors appeared to have no significant influences. The negative effect of smoking was more obvious in patients in their 5th and 6th decades with a distal tibia shaft fractures. CONCLUSION: It seems highly beneficial that patients be recommend to quit smoking while being treated for a fracture, because smoking prolongs the healing time.

Short-term Clinical Results of Total Knee Arthroplasty using Scorpio Design

PURPOSE: The aim of this study was to evaluate the short-term results of total knee arthroplasty using Scorpio design. MATERIALS AND METHODS: Of one hundred thirty knees (75 patients) that were available for review at more than 12 months, 72 knees had been treated with use of a Scorpio PS design (Scorpio group) and evaluated at a mean of 20.2 months and 58 knees with use of a Scorpio SuperFlex design (SuperFlex group) and evaluated at a mean of 13.4 months. RESULTS: The mean Knee Society knee score was 90.8 points in the Scorpio group and 91.1 points in the SuperFlex group at the time of latest follow-up. As assessed at 6 month follow-up evaluation, the mean arc of active flexion was greater in SuperFlex group (119.1 vs 114. 7 degrees). However, there were no statistically significant differences in the mean arc of active flexion between the Scorpio group (119.2 degrees) and the SuperFlex group (121.3 degrees) at the time of last follow-up. CONCLUSION: There are favorable short-term results in primary total knee arthroplasy using either Scorpio PS or Scorpio SuperFlex PS design. There was no significant advantage of the SuperFlex PS design in optimizing active deep flexion as compared with Scorpio PS design at the time of last follow-up.

Differences between Koreans and Americans undergoing Total Knee Replacement Arthroplasty for Primary Osteoarthritis

BACKGROUND: Total knee arthroplasty is a reliable and durable procedure in the treatment of knee arthritis. Patient selection is one scientific aspect of total knee replacement and the surgeon must develop knowledge about those patients who will benefit from total knee replacement. Authors tried to find any differences in preoperative status for Koreans and Americans undergoing total knee replacement arthroplasty(TKRA) for primary osteoarthritis(OA). Another goal of this study was to determine whether Koreans undergoing elective TKIRA for primary OA had more advanced disease preoperatively than Americans undergoing the same procedure. METHODS: Preoperative clinical and radiographic severity of knee OA was determined between Koreans who underwent TKRA at the National Medical Center in Seoul, Korea and Americans who underwent the same procedure at the Hospital of the University of Pennsylvania in Philadelphia, USA. RESULTS: There were 62 women and five men included in the group I(Koreans) compared to 60 women and thirty men in the group II(Americans). The mean age for the patients in the group I was 64.0 years and for the group II 69.5 years. The average weight for the group I was 63.8 Kg(range, 46-85 kg) with an average height of 152.4 cm(range, 133-168 cm). The corresponding data in the group II was 86.6 kg(range, 54-170 kg) and 167.4 cm(range, 147-196 cm). The mean preoperative knee score(developed by The Knee Society) for the group I was 32.7 points and the mean preoperative function score was 42.0 points. The mean preoperative knee and function scores for the group II were 38.1 and 46.2 points, respectively. The mean preoperative flexion contracture and further flexion were 11.7degrees(range, 0-40degrees) and 124.8degrees(range, 70-140degrees), respectively. The corresponding data in the group II were 4.0degrees(range, 0-15degrees) and 107.7degrees(range, 80-130degrees), respectively. The group I knees had a mean preoperative tibiofemoral angle of 4.8degrees(+/-6.0degrees) varus. For the group H knees, the preoperative tibiofemoral angle was 0.83degrees(+/-7.80degrees) valgus. Lateral FT(femorotibial) osteoarthritis was not found in any Korean patients but seen in 18 cases(17.8%) of American patients. CONCLUSION: The observed differences in the status prior to TKRA indicate that Koreans are operated on at a more advanced stage in the course of their disease than Americans. A number of important issues remain to be addressed in future research, such as the role of patient preference and different access to TKRA and the differences of their clinical presentation.

March Fractures of Metatarsals in Infantry Soldiers / 대한정형외과학회잡지

Stress fracture of the metatarsal was first described as March fracture by Breithaupt, a Prussian military surgeon in 1855, According to the classical references, the second metatarsal is the most frequently involved and radiological evidence of fracture appears as late as several weeks. The purpose of this study is to document the incidence and clinical feature of march fractures in Korean military soldiers. From may 1991 to April 1994, at one military hospital in Korea, 52 march fractures in 46 patients were detected among infantry soldiers. There are different findings of fracture site and its clinical features from the previous foreign reports. 1. By physical examination, direct point tenderness on the location of the metatarsal shaft is characteristic, with careful history taking. 2. On roentgenographic examination, cortical fissuring or break is seen one week after onset of symptoms and external callus is seen from two weeks or at the latest four weeks. 3. The third metatarsal is the most frequently involved site(34 cases, 65.4%), and the second metatarsal is less frequent(12 cases, 23.1%) 4. The discrepancy between previous reports and present findings should be emphasized and analyzed in further study.

Treatment of Tibial Nonunion with Subcortical Onlay Bone Graft and Plate Fixation / 대한정형외과학회잡지

Tibial nonunion is often associated with the soft tissue atrophy and the local circulatory disturbance, so it is important to minimize the soft tissue injury and maintain the stability at fracture site for bone union. We reviewed 29 cases of subcortical onlay bone grafts and plate fixations for the nonunion and delayed union of tibial shafts, from Jan. 1988 through Jan. 1994. The results were as follows. 1. Twenty-nine patients who had nonunion of the tibia underwent subcortical cancellous onlay bone graft and plating, and 28 fractures(96.6%) went on to union. 2. Subcortical elevation or shingling of cortical bone fragments of the tibial cortex, is advocated to provide sound biological condition in atrophic soft tissue envelope. 3. Narrow DCP encouraged early motion and reliably promoted obtaining anatomical alignment. So, in treatment of protracted tibial nonunion, especially in an area with deficient soft tissue or unyielding scar tissue, subcortical onlay bone graft and plate fixation is very useful method, result in good union and no skin problem.