Factors Affecting Compliance With Weight-Bearing Restriction and the Amount of Weight-Bearing in the Elderly With Femur or Pelvic Fractures

Objective@#To determine the factors affecting the amount of weight-bearing during gait training in the elderly patients who underwent internal fixation after femur or pelvic fractures and how well they performed the weight-bearing restriction as directed by the physiatrist. @*Methods@#In this retrospective chart review study, we measured the amount of weight-bearing on the affected side in 50 patients undergoing internal fixation surgery and rehabilitation after femur or pelvic fracture using a force plate. Patients receiving non-weight-bearing or partial weight-bearing education were considered to perform weight-bearing restriction well when the amount of weight-bearing was <50 lb. Furthermore, regression analysis was performed to determine the effects of postoperative complications, age, cognitive function, and pain on weightbearing restriction. @*Results@#Variables affecting the amount of weight-bearing were age (r=0.581, p<0.001), weight-bearing education type (r=0.671, p<0.001), manual muscle strength of hip flexion on the non-affected side (r=-0.296, p=0.037), hip abduction (r=-0.326, p=0.021), knee extension (r=-0.374, p=0.007), ankle plantar flexion (r=-0.374, p=0.008), right hand grip strength (r=-0.535, p<0.001), Korean version of Mini-Mental State Examination (r=-0.496, p<0.001), Clinical Dementia Rating (r=0.308, p=0.03), and pain visual analog scale scores (r=0.318, p=0.024). The significant predictor of the amount of weight-bearing among these variables was age (β=0.448, p=0.001). The weight-bearing restriction adherence rate was significantly lower, at 22%, for patients aged ≥65 years as compared to 73% for those <65 years. @*Conclusion@#Age was a major variable affecting the amount of weight-bearing. Compliance with weight-bearing restriction was significantly lower in patients aged ≥65 years than in patients <65 years.

Femoral Head Fracture with Hip Dislocation Treated by Autologous Osteochondral Transfer (Mosaicplasty) - A Case Report -

Femoral head fractures combined with hip dislocation are very rare injuries. In most cases, they result from high-energy trauma to the hip or lower extremity during traffic accidents. Various therapy options have been suggested to treat these injuries. Especially, different joint-preserving surgical options have been described for the treatment of traumatic osteochondral injury of the femoral head in young, active patients. In this report, we present a case that a traumatic osteochondral lesion to the femoral head after hip dislocation was treated with osteochondral autografts (OATS) from the non-weight-bearing area of the ipsilateral inferior femoral head through a surgical hip dislocation. After 1 year, the clinical and radiological outcome was satisfactory with no evidence of posttraumatic osteoarthritis and no pain of patients.

A Comparison between Open Reduction/Internal Fixation and Minimally Invasive Plate Osteosynthesis Using a 3-Dimensional Printing Model for Displaced Clavicular Fractures / 대한정형외과학회잡지

PURPOSE: This study was performed to compare between open reduction/internal fixation (ORIF) and minimally invasive plate osteosynthesis (MIPO) using a 3-dimensional printing model for displaced clavicular fractures. MATERIALS AND METHODS: In a retrospective study, we compared the outcomes of 21 patients treated with MIPO (Group A) with those of 22 patients treated with ORIF (Group B) between January 2013 and December 2015. After the operation, bone union was evaluated using X-ray every 4 weeks. The radiologic outcome (bone union), functional outcome (Korean shoulder scale [KSS], The University of California Los Angeles [UCLA] score), scar length, and degree of satisfaction were evaluated. RESULTS: The mean time to union was 12.1 weeks in Group A and 12.8 weeks in Group B (p=0.524). There was no significant difference in the KSS score and UCLA score between the two groups (p=0.478, p=0.698). The mean length of scar was 4.9 cm (medial 2.6 cm, lateral 2.3 cm) in Group A and 9.7 cm in Group B (p=0.001), and Group A was more satisfied than Group B with respect to scarring (p=0.001). Nonunion developed in one case in each group. Five patients in Group B had skin numbness (1 in Group A, p=0.038). CONCLUSION: There were no significant differences in the radiologic and functional results between the two groups with respect to displaced clavicle shaft fracture. However, scar satisfaction was higher in MIPO than in ORIF.

Is the Incidence Rate of Hip Fractures still Increasing in Korea?: An Epidemiologic Study Based on National Health Insurance Database / 대한정형외과학회잡지

PURPOSE: A retrospective study was conducted to examine the current trend in incidence rates of hip fractures among patients aged 50 years and older in Korea. MATERIALS AND METHODS: A retrospective study was conducted using data on the population, collected by Statistics Korea within the different gender and age groups in total population of Korea from 2007 to 2012. The International Classification of Diseases-10 classification method from the Health Insurance Review and Assessment Service was used to investigate the number of patients with hip fractures, and determine the crude incidence rate (CR) and the age-adjusted incidence rate (AR) for comparison. RESULTS: The CR of hip fractures for patients aged 50 years and older was 178 per 100,000 for men and 350 per 100,000 for women in 2007. In 2012, the CR was 194 per 100,000 for men, and 418 per 100,000 for women. The AR was 197 per 100,000 for men and 281 per 100,000 for women in 2007. In 2012, the AR was 206 per 100,000 for men, and 310 per 100,000 for women. During the observation period, the AR and the CR of hip fractures showed a statistically significant increase. However, the increasing trend has been slowing since its peak in 2010. Comparison of the AR of men and women, showed statistical significance only for women. CONCLUSION: In Korea, the incidence of hip fractures increased significantly from 2007 to 2012. The AR showed statistical significance only for women and the increasing trend is slowing down from 2010.

Psoas and Thigh Abscess Caused by Perforated Retrocecal Appendicitis: A Case Report

STUDY DESIGN: A case report. SUMMARY OF LITERATURE REVIEW: The symptoms of psoas abscess are fever, low back pain, and spasm of the psoas muscle. OBJECTIVES: To report a case of psoas and thigh abscess caused by ruptured appendicitis. MATERIALS AND METHODS: A 53- year old male patient visited the complaining of fever, low back pain and thigh pain. Imaging studies revealed psoas abscess and thigh abscess, accompanied by ruptured appendicitis. Therefore, surgical treatment with percutaneous drainage was performed. RESULTS: The patient recovered and returned to his normal life after 2 months. CONCLUSIONS: It is necessary to identify the cause of the infection using physical examination as well as abdominal and pelvis computed tomography when a patient has fever, psoas abscess and thigh abscess. It is also important to be aware that the cause of psoas abscess may also be gastrointestinal tract disease with non specific symptoms.

Subsidence of Polyetheretherketone Cage after Anterior Cervical Fusion / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the rate and direction of subsidence that occurred after anterior cervical discectomy and fusion using the polyetheretherketone (PEEK) cage and to analyze the risk factors of subsidence. MATERIALS AND METHODS: Thirty two patients (36 segments) who underwent anterior cervical discectomy and fusion using the PEEK cage and autologous cancellous iliac bone graft from July 2003 to November 2011 were enrolled in this study. anterior segmental height (ASH), posterior segmental height (PSH) and cage corner distance (CCD) were measured on plain radiographs. Subsidence was defined as > or =2 mm decrease in the average of ASH and PSH at the final follow up compared to that measured in the immediate postoperative period. A decrease of more than 3 mm was defined as severe subsidence for further statistical analysis. RESULTS: Subsidence of more than 2 mm was observed in 14 segments (38.9%) and severe subsidence (> or =3 mm) was observed in seven segments (19.4%). The direction of subsidence was examined by comparison of means of decreased ASH and PSH and anterior subsidence outweighed posterior subsidence (p<0.001). Examination of CCD showed that inferior subsidence was more frequent than superior subsidence (p<0.001, p=0.047). Among the suspicious risk factors for subsidence, intraoperative disc space distraction (anterior distraction: p=0.031, posterior distraction: p=0.007) and height of inserted cage (p=0.032) showed statistical significance. CONCLUSION: Considerable incidence of subsidence was observed after use of the cage. Using a cage of appropriate height and prevention of intraoperative over-distraction of disc space will be helpful to prevention of subsidence of the cage after anterior cervical discectomy and fusion using the PEEK cage.

Subcutaneous Emphysema of Lower Extremity after Knee Arthroscopy / 대한정형외과학회잡지

Subcutaneous emphysema of lower extremity is a rare disease entity. Crepitation and swelling on physical examination and gas on radiographs raise the concern of infection due to the presence of gas gangrene forming organisms. Therefore, delay of diagnosis and appropriate management can be a major predisposing factor for sepsis and further associated high mortality. We experienced a rare case of subcutaneous emphysema of the right lower extremity after knee arthroscopy; life-threatening infection was ruled out by physical examination and laboratory testing. The patient recovered uneventfully with conservative management. Therefore, we report on this case with a review of current literature.

Effectiveness of the Valgus Reduction Technique in Treatment of Intertrochanteric Fractures Using Proximal Femoral Nail Antirotation / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to investigate the functional and radiologic results of treatment of the old with intertrochanteric fractures by implementation of the proximal femoral nail antirotation (PFNA) with Valgus reduction. MATERIALS AND METHODS: A retrospective review of patients (over 65 years old) with intertrochanteric fractures undergoing PFNA, during the period March 2008 to August 2012 at Chungbuk National University Hospital, with follow-up for at least 12 months, was conducted. Fifty-one patients were identified. The mean observation period was 15.6 months and the mean age of patients was 78.6 years old. In this study, AO foundation and Orthopaedic Trauma Association (AO/OTA) classification of initial fractures, post operative neck shaft angle, location of the blade tip (Cleveland index), tip-apex distance (TAD), incidence of complication, Wayne-County reduction, and Koval walking ability were analyzed. RESULTS: Satisfactory reduced status was achieved by significant (p<0.05) valgus reduction in 49 out of 51 cases and the mean period for radiologic bony union was 15.3 weeks. The mean blade sliding distance was 3.5 mm and the mean TAD was 18.7 mm; however, the blade location did not affect the results. No complications, including surgical site infection, delayed union, nonunion, rotational angulation, and cutting out of the blade tip were found. Thirty-one patients out of 42 who maintained their pre-fracture ambulatory ability, 11 patients (out of 42) remained ambulatory but became more dependent on assistive devices. CONCLUSION: It is expected that the Wayne-County reduction followed by internal fixation with PFNA is a useful treatment option for intertrochanteric fractures in elderly patients because it shows few complications with good functional and radiologic results.

Clinical Outcomes of Anterior Open Reduction and Posterior Percutaneous Screw Fixation for Displaced Talar neck Fractures / 대한족부족관절학회지

PURPOSE: Posteroanterior screw fixation is biomechanically stronger than anteroposterior screw fixation. However, there are few literature about the correlation between clinical results and more strength by posteroanterior fixation. This study was performed to evaluate the clinical outcomes of the accelerated rehabilitation following anterior open reduction and posterior percutaneous screw fixation for displaced talar neck fractures. MATERIALS AND METHODS: Eighteen cases were followed up for more than 1 year after posteroanterior fixation using headless compression screw for talar neck fractures. The clinical evaluation was performed according to American Orthopaedic Foot and Ankle Society (AOFAS) score and Hawkins criteria. As radiographic evaluation, the degree of fracture displacement, period to union, and occurrence rate of complications such as avascular necrosis through MRI were measured. RESULTS: The AOFAS score was average 90.4 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the Hawkins criteria. Therefore, 16 cases(88.8%) achieved satisfactory results. The degree of fracture displacement had improved significantly from preoperative average 5.6 mm to 1.2 mm immediate postoperatively, and maintained to 1.1mm at the last follow-up. All cases achieved bone union, and the period to union was average 12.4 weeks. There were 3 cases of avascular necrosis of talar body and 2 cases of post-traumatic arthritis. CONCLUSION: Anterior open reduction and posterior percutaneous headless screw fixation seems to be an effective surgical method for displaced talar neck fractures, because of the possibility of accurate restoration of articular surface, fixation strength enough to early rehabilitation, and needlessness of hardware removal.

Traumatic Recurrent Dislocation of the Hip with Bankart Type Lesion: A Case Report / 대한고관절학회지

The recurrent dislocation of hip in adult can be uncommonly induced by neuromuscular disease or dysplasia of hip. But in the case of traumatic dislocation of hip with acetabular fracture, the possibility of recurrent dislocation can be decreased if treated with accurate fixation or traction. We have experienced a case of hip dislocation with comminuted acetabular fracture, which was treated only with soft tissue suture and without fixation because of severity of the acetabular fracture. An inappropriate conservative management was done during the post operation period, eventually result in recurrent dislocation and degeneration of posterior wall and head of femur which resembled bony Bankart lesion of the shoulder. The reduction was not able to be maintained, as a result THRA was done. A year after the operation, good prognosis was found in replaced hip without any recurrent dislocation.

Measurement Discrepancy of Sagittal Parameters between Plain Radiography and 3D Computed Tomography in Thoracolumbar and Lumbar Fractures / 대한정형외과학회잡지

PURPOSE: For decision making in the management of vertebral fractures such as operation or not, sagittal parameters like Cobb angle and wedge compression ratio are important. Plain radiography had been the only image tool for measuring such parameters until 3D computed tomography (CT) became popular recently. In this study, we investigated the measurement discrepancy between plain radiography and 3D CT. MATERIALS AND METHODS: Plain radiography and 3D CT of 45 thoracolumbar and lumbar fracture patients (male=21, female=24) were evaluated. We measured sagittal angle and vertebral height on lateral radiography and sagittal CT. Sagittal angle was measured between the upper body and lower body of fractured vertebrae. Anterior and posterior heights were measured to assess anteriorposterior (AP) wedge ratio. RESULTS: The sagittal angle of plain radiography (13.1+/-14.3degrees) was significantly larger than that of 3D CT (8.2+/-13.0degrees) by 4.9degrees (p<0.001). AP wedge ratio of plain radiography was on average 65+/-17%, which was significantly lower than the 3D CT (73+/-17%) by 8% (p<0.001). The severer the initial kyphotic deformity, the more discrepancy of results between the two methods was observed. CONCLUSION: Significant discrepancy was observed in sagittal features of fractured vertebra between plain radiography and 3D CT. Measured values of plain radiography showed more kyphotic features of the fractured body.

Femoral Component Rotation of Total Knee Arthroplasty in Korean Subjects: A Study Using Grand Piano Sign and Computed Tomography / 대한정형외과학회잡지

PURPOSE: We aimed to obtain a reference for the optimal rotational alignment of femoral component in Koreans through an analysis of grand piano sign observed during total knee arthroplasty (TKA) and the angle between the clinical transepicondylar axis and the posterior condylar axis (TEA-PCA angle), by computed tomography. MATERIALS AND METHODS: The study subjects included 24 patients (30 cases), who underwent the anterior femoral resection, which was applied at an external rotation 3degrees relative to the posterior condylar axis during TKA. The relationship between anterior femoral resection with external rotation of 3degrees and the morphological pattern of Grand piano sign was evaluated. On postoperative computed tomography images, we evaluated the relationship between the clinical transepicondylar axis, posterior condylar axis of femoral component and grand piano sign. Moreover, a total of 28 Korean patients with 41 arthritic knees scheduled for a TKA had a preoperative computed tomography. We measured the TEA-PCA angle to evaluate the normal range in Korean subjects. RESULTS: The morphological pattern of grand piano sign observed after the anterior femoral resection, which was applied at an external rotation 3degrees, showed statistically significant correlation with TEA-PCA angle. On preoperative computed tomography images, the TEA-PCA angle was 6.01 degrees (range from 3.90 to 7.86). CONCLUSION: The TEA-PCA angle of Koreans was different from that of the westerners. More external rotation was needed for the optimal femoral rotational alignment theoretically, and we could confirm the correlation between Grand piano sign and rotational alignment of femoral component by measurement of grand piano sign and computed tomography.

The Operative Treatment using Mini-open Sinus Tarsi Approach for Displaced Intraarticular Calcaneal Fractures / 대한족부족관절학회지

PURPOSE: This study was performed to evaluate the clinical outcomes of operative treatment using mini-open sinus tarsi approach for displaced intraarticular calcaneal fractures. MATERIALS AND METHODS: We studied 18 cases (16 patients) of intraarticular calcaneal fractures who were treated with sinus tarsi approach by same surgeon. The mean age of patients was 44.8 years, and mean follow-up period was 17.2 months. The measurement of Bohler angle, Gissane angle, the degree of articular surface depression, and the period to union were performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF). RESULTS: Bohler angle and Gissane angle had improved significantly from preoperative average 9.8degrees, 117.6degrees to average 22.4degrees, 113.4degrees immediate postoperatively, and had maintained to average 21.8degrees and 114.2degrees at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 5.2 mm to 1.2 mm at the last follow-up. All cases achieved bone union, and the period to union was average 10.5 weeks. AOFAS score was average 86.2 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the CNHF scale. Therefore, 16 cases (88.8%) achieved satisfactory results. CONCLUSION: The minimally invasive sinus tarsi approach using headless compression screw seems to be an effective surgical method for displaced intraarticular calcaneal fractures, because of the possibility of accurate restoration of articular surface and the low risk of postoperative soft tissue complications.

Lateral Sliding Calcaneal Osteotomy for Bilateral Talocalcaneal Coalition with Complete Bone Bridge (A Case Report) / 대한족부족관절학회지

Talocalcaneal coalition known as the most common tarsal coalition is a congenital failure of segmentation. Talocalcaneal coalition with complete bone bridge is very rare, and there are few references in the literature about the clinical results and the operative method for this type of tarsal coalition. We report a case of 15 years old female with complete talocalcaneal coalition, who showed good clinical results by lateral sliding calcaneal osteotomy.

The Distal Metatarsal Dorsal-Wedge Osteotomy Using Bio-Compression Screw for Advanced Hallux Rigidus / 대한족부족관절학회지

PURPOSE: This study was performed retrospectively to evaluate clinical outcomes of distal metatarsal osteotomy using bio-compression screw as the joint preservation method for advanced hallux rigidus. MATERIALS AND METHODS: Eleven cases were followed up for more than 1 year after distal metatarsal dorsal wedge osteotomy for advanced hallux rigidus. The clinical evaluation was performed according to the American Orthopaedic Foot and Ankle Society (AOFAS) score and patient's satisfaction score. The range of motion, and the period to return to running exercise, tip-toeing gait, squatting, walking down the stairs were evaluated. As the radiographic evaluation, the interval of 1st MTP (metatarsophalangeal) joint space and the period to union were measured. RESULTS: The AOFAS hallux score had improved significantly from preoperative average 50.7 points to 87.6 points at the last follow-up (p=0.005). The subjective satisfaction score was average 90.6 points. There were no case of subsequent fusion or additional operation, and no complication associated with bio-compression screw. The period to return to running exercise, tip-toeing gait, squatting, walking down the stairs were average of 24.8 weeks, 20.4 weeks, 16.8 weeks, 18.5 weeks respectively. Dorsiflexion of 1st MTP joint had improved significantly from preoperative average 17.5degrees to 44degrees (p<0.001). All cases achieved union of osteotomy site, and the period to union was average 10.4 weeks. The interval of 1st MTP joint space had improved significantly from preoperative average 1.2 mm to 3.5 mm (p=0.014). CONCLUSION: Distal metatarsal osteotomy using bio-compression screw seems to be one of effective treatment methods for advanced hallux rigidus, because of restoration of the first MTP joint motion, and reliable pain relief, and needlessness of hardware removal.

Surgical Treatment Using a Transolecranon Approach with a Dual Locking Plate for Unstable Intercondylar Fractures of the Humerus

PURPOSE: To evaluate the clinical outcomes of operative treatment using a transolecranon approach with a dual locking plate for unstable intercondylar fractures of the distal humerus. MATERIALS AND METHODS: Eighteen patients were followed for more than 1 year after surgical treatment for unstable intercondylar fractures of the humerus. Anterior transpositioning of the ulnar nerve and an early rehabilitation program to allow range of motion (ROM) exercise from postoperative week 1 were used for all cases. The clinical and functional evaluation was performed according to the Mayo Elbow Performance Index and Cassebaum's classification of ROM. RESULTS: The range of elbow joint motion was a flexion contracture mean of 12.8 degrees to a further flexion mean of 119.3 degrees at the final follow-up. The Mayo Elbow Performance Index was an average of 88.5 points. Among the results, 6 were excellent, 9 good, 2 fair, and 1 poor. Therefore, 15 cases (83.3%) achieved satisfactory results. Fourteen cases (77.7%) achieved a satisfactory ROM according to Cassebaum's classification. All cases achieved bone union, and the interval to union was an average of 14.2 weeks. CONCLUSION: Dual locking plate fixation through the transolecranon approach seems to be one of the effective treatment methods for unstable intercondylar fractures of the humerus because it enables the anatomical reduction and rigid fixation of articulation, and early rehabilitation exercise.

Repeated Metal Breakage in a Femoral Shaft Fracture with Lateral Bowing: A Case Report

Fractures of the femoral shaft with marked bowing face some obstacles in fixation of the fracture such as difficulty in insertion of the intramedullary nail (IM nail) or exact contouring plate. Locking compression plates (LCP) are an option to manage this problem. However, we experienced consecutive breakage of LCP twice and IM nail once in an 80-year-old female. Finally, union of the fracture was achieved after fixation of the IM nail and additional plate together. Fractures of the femur shaft with marked bowing are thought to have different biomechanical properties; therefore, we present this case with a review of the literature.

Arthroscopic Bio-Absorbable Suture Anchor Fixation of Tibial Eminence Avulsion Fracture in Children / 대한정형외과학회잡지

Surgical treatment for the pediatric anterior cruciate ligament (ACL) avulsion fracture consists of arthroscopic treatment and open surgery. Recently, arthroscopic treatment has been commonly performed rather than open surgery because of less post-operative pain and faster rehabilitation. In arthroscopic treatment, K-wire and cannulated cancellous screws are the main instruments used for fixation of avulsion fracture, but these instruments have the risk of causing damage to the growth plate and an additional surgery to remove the fixation is needed. In spite of the technical difficulty, the suture anchor is used to overcome the risk of damage to the growth plate and the need for an additional surgery. The authors report good results using bio-absorbable suture anchor in arthroscopic treatment for pediatric ACL avulsion fracture.

Concomitant Fracture of the Lateral Process of the Talus and the Sustentaculum Tali of the Calcaneus / 대한정형외과학회잡지

Concomitant fracture of the lateral process of the talus and the sustentaculum tali of the calcaneus is a rare injury. There are few references in the literature that comment on the precise injury mechanism and the operative method for this type of fracture. We achieved satisfactory clinical results in 2 cases of concomitant fractures of the lateral process and the sustentaculum tali resulting from traffic accidents. We used a method of open reduction and internal fixation. We report these cases with a review of the relevant foreign literature because of no previous report in Korean literature.

Efficacy of Interscalene Block Anesthesia on the Early Postoperative Pain after Arthroscopic Shoulder Surgery: Comparison with General Anesthesia / 대한정형외과학회잡지

PURPOSE: After shoulder arthroscopy via general anesthesia, most patients complain of severe pain during the early post operative period. In this study, the efficacy of pain control during the early post operative period with interscalene block anesthesia for shoulder arthroscopy was investigated and compared with general anesthesia. MATERIALS AND METHODS: A prospective randomized controlled study was conducted on 40 patients who underwent shoulder arthroscopy between September 2008 and March 2009. The patients were grouped according to the method of anesthesia. The visual analogue scale (VAS) at the preoperative and early postoperative periods was checked and compared. In addition, the duration of patient controlled analgesia (PCA) usage and additional pain killer injections were examined. RESULTS: There was no significant difference between the two groups for the VAS score before surgery, but the interscalene block group showed a significantly lower VAS score. The duration of PCA usage was also significantly longer for the interscalene block group, which implies less pain. The number of additional pain killer injections was significantly less in the interscalene block group. CONCLUSION: The patients who underwent shoulder arthroscopy with interscalene block had significantly less pain during the immediately post operative period for up to 48 hours. So patients could conduct initial rehabilitation and experience minimized side effects caused by analgesics due to the decreased use of pain killer. Therefore, interscalene block is considered a good method of anesthesia for the immediate postoperative pain control after shoulder arthroscopy.