Bipolar Hemiarthroplasty with Cementless Femoral Stem for Unstable Intertrochanteric Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the usefulness of bipolar hemiarthroplasty using a cementless femoral stem for treating unstable intertrochanteric fractures in elderly patients. MATERIALS AND METHODS: This study included 41 hips of 41 patients who were followed up for over 2 years after bipolar hemiarthroplasty using cementless femoral stem between October 2006 and November 2008. The mean follow-up period was 33 months (24-42 months). RESULTS: At the last follow-up, the mean Harris hip score was 81.3 points. All stems were stable without significant changes in alignment or progressive subsidence. There were no cases of leg length discrepancy over 5 mm. There were 3 cases of wire fixation breakage and 1 case of posterior hip dislocation. CONCLUSION: The short-term results over 2 years of clinical and radiological evaluation of cementless bipolar hemiarthroplasty and wire fixation were satisfactory in elderly patients with unstable intertrochanteric fracture.

The Value and Limitation of the Modified Mau Osteotomy(30 Cases Follow Up Report) / 대한족부족관절학회지

PURPOSE: To evaluate the value and limitation of modified Mau osteotomy through the review of 30 feet treated by this procedure. MATERIALS AND METHODS: We retrospectively analyzed 30 cases treated with modified Mau osteotomy since 2002. The mean duration of follow-up was 10 months. We reviewed medical records to describe each case and select several clinical factors which related with surgical procedure and could influence on final results. We measured radiographic parameters such as hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position and also assessed clinical outcomes by AOFAS score and satisfaction degrees. RESULTS: The mean preoperative HVA and IMA were 40.4degrees, 17.4degrees and the mean amounts of correction were 31.2degrees and 11.5degrees. Amounts of delayed loss of correction were 16.8% in HVA and 19.2% in IMA. Initial HVA, rotational angle and translation distance of the distal fragment, stability of fixation, first ray instability were revealed as significant factors for the final result from this procedure. DMAA was increased by rotation of the distal fragment and decreased by adding translation on the rotation. CONCLUSION: Modified Mau osteotomy is an effective procedure to get enough correction. But, it is important to try to avoid excessive rotation of the distal fragment because it may worse joint congruity. It may be worthwhile to pay close attention to the direction of saw and stability of fixation.

Treatment of Infected Total Hip Arthroplasty

PURPOSE: To analyze the effectiveness of a two-stage revision surgery for an infected total hip arthroplasty. MATERIALS AND METHODS: Between 1988 and 2005, twenty-four patients (24 hips, 18 males, 6 females) with documented infection of total hip arthroplasty were reviewed and followed for at least two years postoperatively. The preoperative and postoperative clinical and radiologic findings and blood laboratory work were compared. Eight arthroplasty cases were performed through retention of the femoral stem and removal of the acetabular cup with cementing by impregnated antibiotics in the first stage of the operation, and subsequent acetabular cup revision in the second stage of the operation. RESULTS: After the first stage of the operation, infectious organisms were cultured in 19 patients, and isolated Staphylococcus aureus was cultured in 14 patients. The mean follow-up period was 8.2 years, and the average Harris hip score improved to 88.4 points at last follow-up. Radiologic osteolysis was noted in 5 cases, and possible loosening was demonstrated in 1 case. The erythrocyte sediment rate (mm/hr) and C-reactive protein (mg/L) were 43.8/14.2 preoperatively and 17.9/8.3 postoperatively. There were 2 recurrences of infection, for an eradication rate of 91.7% (22 of 24). CONCLUSION: Two-stage revision for an infected total hip arthroplasty proved to be an excellent method with a high eradication rate.

Long Level (T4-L1) Spinal Epidural Abscess in a Diabetic Patient: A Case Report

Spinal epidural abscesses are uncommon, but potentially devastating and often fatal. They can be found in normal patients, but they are more prevalent in immunocompromised patients, such as intravenous drug users, diabetics, chronic renal failure patients, pregnant women, and others. Timely diagnosis and treatment are the keys to optimizing outcome. Traditionally, treatment has comprised parenteral antibiotics and possible surgical intervention, such as decompression by pus drainage. We treated a long level (T4-L1) epidural abscess in a diabetic patient who had to undergo emergent long level decompression and drainage due to complete paralysis of the lower extremities and progression of neurologic deficit toward the upper thoracic level. Although lower extremity paralysis has not improved, the patient has completely recovered from lower extremity anesthesia. Further follow-up was not done because the patient expired due to sepsis eight month after surgery.