Factors Affecting Clinical Results after Corrective Osteotomy for Lumbar Degenerative Kyphosis

STUDY DESIGN: This study is a prospective, clinical study for lumbar degenerative kyphosis. PURPOSE: To determine the factors affecting postoperative clinical outcomes in patients who undergo corrective osteotomy for lumbar degenerative kyphosis. OVERVIEW OF LITERATURE: Only a small number of studies have reported clinical results for surgery for lumbar degenerative kyphosis. There are almost no studies about prognostic factors that predict postoperative clinical results. METHODS: This study involved 25 patients who were diagnosed with lumbar degenerative kyphosis and who underwent corrective osteotomy following gait analysis. A pedicle subtraction osteotomy was done at the third lumbar vertebra (L 3). Regarding the fusion level, surgery was done within a range from T10 proximally to S1 distally. Of these, for rigid fixation of a distal part, an iliac screw was used. Pain was evaluated using a 10-point pain scale and a questionnaire about activities. We also evaluated cosmesis and subjective satisfaction using a modified version of the Scoliosis Research Society Outcome-22 (SRS-22) instrument. This assessment was done using a 5-point scale which was designed by us. We assigned patients to group A (good clinical outcomes) if their postoperative pain score was lower than 4 (of 10 points) and if scores indicating activity, cosmesis and subjective satisfaction were higher than 11 (of 15 points). All other patients were assigned to group B (poor clinical outcomes). RESULTS: Clinical outcomes were good in 64% of patients (16/25) and poor in 36% (9/25). Regarding cosmesis and subjective satisfaction, there were significant differences between the two groups. There were also significant differences in physical factors of individual patients such as body mass index (BMI): 23.78 +/- 2.79 in group A and 26.44 +/- 2.75 in group B. On gait analysis, there was a significant difference in the dynamic pelvic tilt: 7.5 +/- 3.3degrees in group A and 11.72 +/- 1.89degrees in group B. CONCLUSIONS: There is no correlation between preoperative degree of kyphotic deformity and clinical outcomes. The degree of anterior rotation of pelvic tilt does not change significantly; rather, compensatory mechanisms of the pelvis and BMI were found to have more influence. Because neither the degree of satisfaction with clinical outcomes nor the increased activity was relatively higher, a more sincere decision should be made before recommending corrective osteotomy for degenerative lumbar kyphosis.

Analysis of Risk Factors and Surgical Results of Lumbar Adjacent Segment Disease

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We analyzed the risk factors and the surgical results for adjacent segment disease after lumbar fusion. SUMMARY OF LITERATURE REVIEW: Many studies have been performed about the risk factors for adjacent segment disease, but the findings are still controversial. MATERIALS AND METHODS: This study was carried out on 35 (13 men, 22 women) of 50 patients who underwent lumbar fusion due to adjacent segment disease with a minimum of 2 year follow-up period from July 1999 to July 2006. The differences of the interval to revision (IR) were statistically analyzed by the examining preexisting degenerative change in the adjacent segments on MRI, the number of fused segments, the lumbar lordosis and the sagittal balance. The surgical outcomes of reoperation were assessed by Brodsky's criteria. RESULTS: Junctional stenosis as adjacent segment disease was seen in 21 cases (60%) and instability was seen in 14 cases (40%), including 2 iatrogenic flat backs and 2 cases of lumbar degenerative kyphosis. The average IR was 93 months for the cases that had less than 2 segment fusion (20 cases) and 62 months in those with more than 3 segment fusion (15 cases). As for lumbar lordosis, 25 cases (71%) had a normal range of angle as well as 101 months until the IR and 10 cases (29%) had an abnormal range of angle as well as 64 months until IR. Six cases were beyond the normal range of sagittal balance (17%) and their average IR value was 59 months. Otherwise, the cases with a normal range of sagittal balance had 109 months for the IR. The clinical outcome was excellent in 6 cases (17%) and good in 15 cases (43%). CONCLUSION: To decrease the adjacent segment disease, we should seriously consider the extent of lumbar fusion and we should restore the angle in lumbar lordosis to the physiological range and the sagittal balance during the initial operation.

Radiologic Analysis of Postoperative Sagittal Plane Correction in Lumbar Degenerative Kyphosis (LDK) / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study OBJECTIVES: We radiologically analyzed the correction of the sagittal imbalance and the proximal fusion level to prevent correction loss and the usefulness of iliac screws in LDK. SUMMARY OF THE LITERATURE REVIEW: Complications can be encountered during fixation and fusion as most of the LDK patients are aged, and the osteoporosis that causes fixation loss is known to affect the loss of correction. MATERIALS AND METHODS: We analyzed the cause of correction loss among 35 patients who underwent surgery and who were followed up for at least 1 year. All the patients had performed gait analysis before operation. The operative techniques were pedicle subtraction osteotomy and fixation to S1. For analyzing causes of correction loss, we analyzed the degrees of lumbar lordosis for the sagittal correction and the degrees of the preoperative thoracolumbar kyphosis for the proximal fusion range. For analyzing the usefulness of iliac screws, the subjects were divided into two groups: 1) the -iliac screw (23cases) group for the patients who were fixed without iliac screws and 2) the +iliac screw (12cases) group for the patients who were fixed with iliac screws. RESULTS: There were no patients who had marked anterior pelvic tilt. It is important to correct the lumbar lordosis over 20degrees compared with the preoperative thoracic kyphosis. There are 10 cases of preoperative thoracolumbar kyphosis > or = 10degrees and 25 cases of preoperative thoracolumbar kyphosis or = 10degrees, 4 cases that were fixed to T10 had no sagittal correction loss, and 2 of the 6 cases that were fixed to T11 or T12 had sagittal correction loss. For the 25 cases of preoperative thoracolumbar kyphosis < 10degrees, 5 cases that were fixed to T10 had no sagittal correction loss and 1 of the 20 cases that were fixed to T11 or T12 had sagittal correction loss (p<0.05). 6 cases (26%) in the -iliac screw group (23 cases total) and 1 case (8%) in the +iliac screw (12 cases total) showed sagittal correction loss (p<0.05). CONCLUSIONS: It is important to make the postoperative lumbar lordosis over 20degrees compared with the preoperative thoracic kyphosis for correcting sagittal imbalance, to decide on the proximal fixation level according to the preoperative thoracolumbar kyphosis and to fix with iliac screws.

Change of Pelvic Tilt before and after Gait in Patients with Lumbar Degenerative Kyphosis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to verify the value of radiography and gait analysis to analyze the changes of the pelvic tilt before and after gait in the patients with LDK. Summary of Literature Review: Patients with lumbar degenerative kyphosis show dynamic changes that are closely associated with the motion of pelvis. MATERIALS AND METHODS: We analyzed 18 lumbar degenerative kyphosis patients who didn't have multiple vertebral compressio fractures, a past history of spinal surgery or surgery for degenerative arthritis of the knee or hip, and obesity which causes marker errors on the gait analysis. Pelvic tilt was statistically evaluated by utilizing radiographs and dynamically utilizing the gait analysis. The linear parameters of the gait cycle and the kinematic data were obtained from the gait analysis. RESULTS: The LDK patients'mean walking velocity was 80.7 cm/s, and it was largely decreased to 65% of the normal value. The cause of the decreased walking velocity was a decrease of stride length, and not a decrease of cadence. The mean static pelvic tilt in the gait analysis was -1.3+/-8.0degrees , and there were 8 cases of anterior tilt and 10 cases of posterior tilt. The mean pelvic tilt during gait was 12.5+/-8.2degrees , and there were 17 cases of anterior tilt and 1 case of posterior tilt. It was statistically significant difference (p<0.05) between the mean static pelvic tilt in gait analysis and the mean pelvic tilt during gait and the Pearson's correlation coefficient was -0.88. CONCLUSIONS: Though there was no statistical significance, we observed anterior pelvic rotation after gait on the radiographs. As fatigue of the pelvic extensor muscles increases during gait, anterior pelvis tilt increases with statistical significance on the gait analysis. Therefore, we feel gait analysis is useful for evaluating the dynamic change of the pelvic tilt in patients with LDK.

Degenerative Changes of Adjacent Segment after Anterior Cervical Discectomy and Fusion / 대한척추외과학회지

STUDY DESIGN: A retrospective radiologic analysis of 34 patients OBJECTIVES: To evaluate the factors influencing the radiographic degenerative changes in the adjacent segments in one-level ACDF SUMMARY OF LITERATURE REVIEW: There is a 25% incidence of adjacent segment degeneration after 5 years. MATERIALS AND METHOD: From 2002 to 2005, 34 patients (male 23, female 11) underwent anterior cervical spine fusion using a cage or bone block for degenerative cervical spine. The mean age of the patients was 51 years and the mean follow-up period was 24 months. The degenerative findings of the upper and lower adjacent segment were measured from the pre-operative MRI. The fused segment curvature, disc heights of the adjacent segments, displacement of the vertebral bodies and angular mobility in the adjacent segments were measured from the pre-operative and final follow-up lateral views in the neutral position, in both flexion and extension. RESULTS: Degenerative changes in the adjacent segments were observed in 19 of the 34 patients. The group with degenerative changes showed significantly more lordotic angular loss of the fusion segments (11.9+/-3.1degrees) at the follow-up observation than the group with no degenerative changes (9.0+/-1.1degrees) (p=0.04). The group with degenerative change showed a significantly larger increase in disc height of the fusion segments (2.8+/-0.2 mm) at the follow-up observation than the group with no degenerative changes (2.2+/-0.3 mm) (p=0.02).The group with a Grade IV or higher level of pre-operative disc degeneration showed more degenerative changes in the adjacent segments than those with Grade III or lower. CONCLUSIONS: It is important to preserve the lordotic angle of fused segments and avoid excessive increases in disc height. The recurrence of the neurological is not associated with the preoperative adjacent segmental degenerative changes in ACDF.

Metal Failure in patients with Short-segmental Pedicle Screw Fixation and Fusion for Degenerative Lumbar Disease: Comparison Monoaxial with Polyaxial Screw / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVE: To evaluate the factors affecting metal failure and screw loosening of short-segmental (1- or 2-segmental) monoaxial or polyaxial screw fixation for degenerative lumbar disease. SUMMARY OF LITERATURE REVIEW: There was a report on metal failure and screw loosening in short-segmental monoaxial and polyaxial screw fixation in degenerative lumbar disease. MATERIALS AND METHODS: This study examined 227 cases who underwent short-segmental transpedicular screw fixation and vertebral fusion for a degenerative lumbar. RESULTS: Metal failure of transpedicular screws was detected in 6 cases, 3 each in groups A and B. Screw loosening occurred in 16 and 43 cases in group A and B, respectively. Both groups had a similar incidence of spinal stenosis with instability and spondylolisthesis. The failure rate and screw loosening according to the fusion level was also similar. The failure and screw loosening rates was higher in the cases who did not undergo PLIF than in the cases who underwent PLIF but the difference was not statistically significant. CONCLUSION: The metal failure and screw loosening rates after transpedicular screw fixation and spinal fusion procedures for degenerative lumbar diseases using monoaxial screws and polyaxial screws were similar.

Analysis for Etiology of Correction Loss after Surgical Treatment of Osteoporotic Vertebral Fracture with Neurologic Deficits / 대한척추외과학회지

STUDY DESIGN: A retrospective radiologic study of 23 cases OBJECTIVES: This study evaluated the etiology of correction loss after surgical treatment of osteoporotic vertebral fractures with neurologic deficits SUMMARY OF LITERATURE REVIEW: osteoporotic vertebral fractures with neurologic deficits were treated with anterior decompression with posterior instrumentation or an Egg shell operation. MATERIALS AND METHODS: We experienced 23 cases treated surgically for osteoporotic vertebral fracture with neurologic deficits. In group A (16 cases), anterior decompression with posterior instrumentation were performed, with group B (7 cases) receiving an Egg shell operation. The kyphotic angle using Cobb's method and endplate injury were evaluated preoperatively, postoperatively, and at last follow up. Group A was subdivided into A1 and A2 according to preoperative and postoperative kyphotic angle, as well as being divided by endplate injury into subgroup a and b. Overcorrection of preoperative kyphotic angles were performed in A1, and undercorrection in A2 group, with endplate injury in subgroup a. RESULTS: Postoperative correction was 13.4 degrees+/-3.4degrees and correction loss was 9.68degrees+/-8.05degrees in group A, and 21.5degrees+/-5.0degrees and 8.0degrees+/-1.73degrees in group B, respectively. Correction loss of group A1 (13.4degrees +/-8.8degrees ) was significantly larger than A2 (4.71degrees +/-3.14degrees ) (p=0.011). The correction loss of group A1a (18.0degrees +/-9.3degrees ) was significantly larger than group A2 (8.5degrees +/-3.1degrees ) (p=0.050) and A2a (p=0.036). The correction loss of group A1b was significantly larger than group A2b (p=0.029), and correction losses were not significantly different in A2a (6.0degrees +/-4.0degrees ) and A2b (3.25degrees +/-1.7degrees ) (p=0.289). CONCLUSIONS: Less Correction loss was found in the undercorrection and non-endplate injury group

Availability of Anterior Cervical Plating in Distractive Flexion Injury in Lower Cervical Spine: Radiologic Aspects / 대한척추외과학회지

STUDY DESIGN: A retrospective clinical and radiological analysis. OBJECTIVES: To evaluate the availability of anterior cervical plating in the treatment of distractive-flexion injuries of the lower cervical spine. SUMMARY OF LITERATURE REVIEW: Surgical approaches for distractive-flexion injuries of the lower cervical spine have included the anterior approach, the posterior approach, and the combined anterior and posterior approach. However, which approach is the most useful remains a controversial issue. MATERIALS AND METHODS: We reviewed the outcomes of 30 patients, who were followed-up for an average of 16 months (range, 12-43 months) after undergoing fusions with anterior cervical plating for distractive-flexion injuries of the lower cervical spine from July 1995 to July 2004. The average age of these patients was 52.9 years (range 24-77 years) and male-to-female ratio was 26:4. Group A consisted of 19 cases that were composed of unilateral dislocations and Group B consisted of 11 cases that were composed of bilateral dislocations based on Allen s classification. Group A1 (9 cases) and B1 (8 cases) were composed of cases that had fractures on the superior end plates or facet joints of the lower cervical spine in each group. Group A2 (10 cases) and B2 (3 cases) were composed of cases without fractures in each group. Neurologic symptoms were evaluated by the Frankel classification; and the angle of lordosis, disc height, and duration of bony union were analyzed postoperatively and with the last follow-up roentgenograms. RESULTS: Clinically, 22 (73%) patients had neurologic deficits, which were composed of 9 (41%) cases of complete injury, 7 (32%) cases of incomplete injury, and 6 (27%) cases of nerve root injury. The nerve root injuries recovered in all cases and the incomplete injuries had an average 1.7 grade recovery by the Frankel classification. Radiologically, the loss of lordosis was 2.2+/-1.7degrees in group A, 3.1+/-2.8degrees in group B (p=0.359), 3.0+/-1.6degrees in group A1, 1.5+/-1.5degrees in group A2 p=0.048), 3.5+/-3.1degrees in group B1, and 2.1+/-1.7degrees in group B2. Loss of disc height was 1.7+/-1.1 mm in group A, 2.2+/-0.9 mm in group B( p=0.201), 2.2+/-0.9 mm in group A1, 1.2+/-1.0 mm in group A2 (p=0.046), 2.5+/-0.6 mm in group B1, and 1.2+/-1.1 mm in group B2. The duration for bony union was 12.9+/-2.8 weeks in group A, 14.1+/-2.7 weeks in group B (p=0.044), 13.9+/-2.1 weeks in group A1, 11.9+/-3.0 weeks in group A2 (p=0.046), 14.4+/-2.9 weeks in group B1, and 13.3+/-2.3 weeks in group B2. There was no graft displacement, nonunion or metal failure. CONCLUSION: Anterior cervical plating was an effective treatment modality for distractive-flexion injuries of the lower cervical spine. and more firm method was necessary to surgical treatment in case of fractures on superior end plate or facet joint.

Clinical Outcome of Conservative Treatment for Osteoporotic Compression Fractures in Thoracolumbar Junction / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To validate a treatment plan by analyzing the clinical outcome of conservative treatment for patients with osteoporotic vertebral compression fractures at thoracolumbar junctions. SUMMARY OF LITERATURE REVIEW: Osteoporotic vertebral compression fractures, without neurological symptoms, have been treated by conservative management; however, serious sequelae of the osteoporotic vertebral compression fractures have been reported by many investigators. MATERIALS AND METHODS: We evaluated 83 cases; 68 patients had an average age of 71.1 years (58 to 99 years). After conservative treatment of the osteoporotic compression fractures, and based on the clinical outcome derived from a 10-point pain rating scale at last follow up, the group was sub-divided into two groups. Group A (N=28): had a score of above five points on the pain scale. Group B (N=55): had a score of less than five points on the pain scale. Evaluation of the correlation between the clinical outcome and factors affecting outcome such as vertebral body height loss, change in height loss, BMD and bracing were recorded at the initial and follow up assessment. RESULTS: The mean VAS score was 3.20+/-1.62, and the mean compression ratio was 24.74+/-12.03% at injury and 21.68+/-11.43% at the last follow-up. The mean compression ratio at injury was 27.67+/-10.50% in group A and 23.25+/-10.57% in group B. The mean compression ratio at the last follow-up was 53.43+/-13.31% for group A and 42.86+/-13.74% for group B. The change in compression ratio was 25.76+/-12.68% in group A and 19.60+/-10.25% in group B. The mean BMD was -3.63+/-1.16 for group A and -2.80+/-1.10 for group B. The compression ratio at last follow-up, change of compression ratio and BMD were significantly different in comparisons between group A and B (p=0.001, 0.031, 0.003, respectively). CONCLUSION: The clinical outcome of osteoporotic compression fractures was related to the compression ratio, and the compression ratio was related with BMD. Patients with osteoporotic compression fractures with a compression ratio of more than 30% and a T-score from the BMD of less than -3.5 require active treatment.

Prognostic Factors Affecting the Surgical Outcome of the Cervical Myelopathy / 대한정형외과학회잡지

PURPOSE: To investigate and define the clinical results and prognostic factors affecting surgical outcome of the various etiologies of a cervical myelopathy. MATERIALS AND METHODS: Forty-one cervical myelopathy patients, who underwent surgery from March 1997 to March 2004, were retrospectively reviewed. The patients were divided into three groups according to the cause, HIVD (10 cases, group A), OPLL (14 cases, group B), cervical spondylotic myelopathy (17 cases, group C). An anterior cervical discectomy and fusion was carried out on one or two segments in group A, and an expansive open-door laminoplasty was performed in groups B and C. The correlations between age, onset, preoperative JOA score, signal change in the cord on the T2 weighted image MRI, compression ratio, which are known etiologies of myelopathy, and the recovery rate according to causes were analyzed. RESULTS: The mean preoperative and postoperative JOA score was 11.2 and 14.6 respectively. The mean recovery rate was 61.7%. There was no significant difference in the preoperative JOA score in each group (11.40 in group A, 11.93 in group B, 10.53 in group C). The recovery rate was ranked as follows: group A, B, and C (group A 75.98%, group B 61.39%, group C 53.61%) but the difference was not significant. Age, preoperative JOA score, signal change on T2WI MRI in group A (p<0.05), age, preoperative JOA score in group B (p<0.05), age, preoperative JOA score, signal change on T2WI MRI, compression ratio in group C (p<0.05) were significant prognostic factors that influenced the recovery rate. CONCLUSION: There was no difference between the preoperative clinical symptoms and the surgical outcome according to the cause. The most significant prognostic factors affecting the results of surgery for cervical myelopathy were age, preoperative JOA score in each group. A specific prognostic factor in each group may exist, but a further evaluation is needed.

Radiological and Clinical Analysis of Degenerative Lumbar Retrolisthesis: Comparative Study of Degenerative Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to analyze the radiological features of degenerative lumbar spondylolisthesis and retrolisthesis, and we wanted to verify what radiological factors are related to the development of the retrolisthesis. We also wanted to determine these radiological factors' clinical significance. SUMMARY OF THE LITERATURE REVIEW: There is little information about the pathological mechanism and the clinical and radiological aspects of degenerative lumbar retrolisthsis. MATERIALS & METHODS: Sixty patients were reviewed and divided into three groups. The degenerative lumbar retrolisthesis patients were in group A. The degenerative lumbar spondylolisthesis patients were in group B. Group C patients had no vertebral shift in any direction. The factors we measured were the facet joint angle, the disc height of L3-4, L4-5 and L5-S1, and the lordosis of the lumbar spine. The evaluation of the clinical results was then quantified. RESULTS: The facet joint angle showed no statistical significance between the two groups. The disc height of group A at L4-5 and L5-S1 was more decreased in group A than in group B (p<0.05). Lumbar lordosis was decreased significantly in group A (p<0.05). The preoperative pain was improved at the final follow up, but preoperative pain was significantly higher in group A than in group B (p<0.05). The clinical results were improved in each group, but there was no statistically significant difference between the two groups. CONCLUSIONS: The disc height and lumbar lordosis were considerably reduced in the patients with retrolisthesis, especially compared to those patients with spondylolisthesis. Preoperative pain was higher for the retrolisthesis patients than for the spondylolithesis patients, but there was no significant difference.

Surgical Outcome of Degenerative Lumbar Spinal Stenosis in Patients over 70 years old: A Comparative Analysis according to Surgical Method / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze and compare the clinical results of different surgical methods for spinal stenosis, without lumbar instability, in patients over 70 years-old. SUMMARY OF LITERATURE REVIEW: Much controversy exists as to the best operative method for spinal stenosis. MATERIALS AND METHODS: Thirty eight patients that had undergone surgical treatment for spinal stenosis, without lumbar spinal instability, with a mean age of 75.1 years(70 to 91 years) and follow up period was 44 months(24 to 52 months), were retrospectively reviewed. The patients were divided into two groups: * Group A (n=23): posterior decompression alone * Group B (n=15): posterior decompression and posterolateral fusion Clinical outcome and satisfaction were assessed using Bohlman's measurements, on a 10 point pain rating scale, and the clinical outcomes were further analyzed according to the co-morbidity and postoperative complications. RESULTS: Clinically excellent and good outcomes were achieved in 86.9 and 80.0% in groups A and B, respectively. The 10-points pain scale for low back pain showed improvements in both groups. The co-morbidity did not influence the clinical outcome in either group. There were no serious postoperative complications in either group. CONCLUSIONS: Posterior decompression alone was an effective surgical method, and was found to be equivalent to posterior decompression and posterolateral fusion in patients over 70 years-old with degenerative lumbar spinal stenosis and without lumbar spinal instability.

Availability of Intradiscal Injection of Marcaine as a Pain Relief Test for Diagnosis of Internal Disc Disruption / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To investigate the availability of an intradiscal injection of marcaine as a pain relief test to enhance specificity in the diagnosis of IDD. SUMMARY OF LITERATURE REVIEW: The diagnosis and treatment of IDD have been controversial. A discography, which has been widely used for the diagnosis of IDD, has many problems that might result in a faulty diagnosis. MATERIALS AND METHODS: Twenty nine patients, with an average age and duration of symptom of 36.9 years (22 to 46 years) and 5 years 1 month (6 months to 10 years), respectively, were reviewed. After the discography, the marcaine was injected. Based on the responses after the injection, the group was sub-divided into a further two groups. Group A (n=19): transient pain relief and surgical treatment was performed. Group B (n=10): no pain relief and conservative treatment was performed. An analysis to examine the correlation between the response to marcaine and age, duration of symptom, subjective pain level, number of disc degeneration and high intensity zone was also performed, and the clinical results quantified. RESULTS: The agreement rate between the discography and response to marcaine was 55.2%. The longer the symptom duration, the more meaningful were the responses to the marcaine injection (p<0.05). The result of surgical treatment was important statistically, as the pain was relieved from 8.6 +/- 0.97 to 1.8 +/- 0.42 points, and the ODI decreased from 68 +/- 16.92 to 30 +/- 9.97% (p<0.05). CONCLUSIONS: An intradiscal injection of marcaine, as the pain relief test, can enhance the specificity for the diagnosis of IDD.

Scapholunate Dissociation Associated with Distal Radius Fracture / 대한정형외과학회잡지

PURPOSE: To analyze the relationship of fracture patterns in cases diagnosed as scapholunate dissociation after treatment for distal radius fracture. MATERIALS AND METHODS: Forty-six cases were analyzed clinically and radiographically. Twenty-four cases were treated by closed reduction and percutaneous k-wire fixation, twelve cases by closed reduction, k-wire and external fixator application, and ten cases by open reduction and plate fixation. For radiological evaluation, scapholunate gap, scapholunate angle, and radiolunate angle were analyzed to detect scapholunate dissociation and dorsal intercalated segmental instability. RESULTS: In the 7 cases with a borderline scapholunate gap (>2 mm), 3 cases with an initial fracture line involving the interfacet prominence progressed to static scapholunate dissociation. CONCLUSION: Initial scapholunate gap and fracture line geometry of the distal radius were helpful for predicting progression to static scapholunate dissociation

Ankle Arthrodesis Using the Transfibular Approach / 대한정형외과학회잡지

PURPOSE: We analyzed the clinical and radiological results of transfibular ankle arthrodesis for posttraumatic arthritis. MATERIALS AND METHODS: Eighteen cases of transfibular ankle arthrodesis were followed for more than 12 months postoperatively. Mean age was 55 years, and the mean follow-up period was 2.9 years. Preoperative and postoperative AOFAS ankle-hindfoot scores, operative times, postoperative complications and patients satisfaction level were checked. Radiologically preoperative ankle deformity, time to union, position of fusion, residual tarsal motion arc and degenerative changes of adjacent foot joints were evaluated. RESULTS: At the last follow-up, the mean AOFAS ankle-hindfoot score had increased from a preoperative 41 points to 79 points. Sixteen patients (89%) were satisfied with the result. The mean operative time was 108 minutes. Three cases of chronic tear of the peroneus brevis tendon were treated. Mean time to radiological union was 13.1 weeks. No degenerative changes in adjacent foot joints were observed at the last follow up. Two cases (11%) of nonunion and one case (5.5%) of delayed union were observed. Revision of arthrodesis was performed in one case of nonunion. CONCLUSION: Satisfactory results were obtained after transfibular ankle arthrodesis for posttraumatic arthritis. Long-term follow up is needed to evaluate the effects of ankle arthrodesis upon adjacent foot joints.