Decompression effect after Carpal Tunnel Release using the Limited Proximal One-incision Technique / 대한정형외과학회잡지

PURPOSE: Carpal tunnel decompression using the limited one incision technique in carpal tunnel syndrome is difficult to evaluate in terms of postoperative improvement and complications. We analyzed the clinical efficacy by defining the effect of decompression after carpal tunnel release using the modified limited proximal one-incision technique. MATERIALS AND METHOD: Symptoms and signs (pain, paresthesia, Phalen test and Tinel sign) were analyzed in 35 patients, 63 hands, which were followed up for a year or more, among patients who had been operated upon using the limited proximal one-incision technique from January, 1994 to June, 1999. RESULT: Pain was relieved two weeks after the operation. Paresthesia, two-point discrimination, Phalen test, and Tinel sign improved progressively postoperativley. According to the Cseuz criteria, 53 hands (84%) were estimated to degreesgood "12 months after operation. CONCLUSION: The carpal tunnel can be released using a limited proximal one-incision technique, has few complications and produces results comparable with standard classical decompression or the endoscopic carpal tunnel release. Patient satisfaction was good at 12 months postoperatively. We suggest that carpal tunnel syndrome requires long-term follow-up and analysis.

Indirect Signs of Magnetic Resonance Imaging of the Knee with Anterior Cruciate Ligament Tears: Comparison between Acute and Chronic ACL Tears / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to assess the differential features of indirect signs at magnetic resonance (MR) imaging in acute and chronic tears of the anterior cruciate ligament. MATERIALS and METHODS: Preoperative MR imagings of 71 patients (71 knees) who were confirmed as complete tear of anterior cruciate ligament (ACL) by arthroscopy were evaluated. On MR imagings of acute (n=47) and chronic (n=24) tear of ACL, and of the control group (n=31) , we reviewed bone bruise, posterior displacement of the lateral meniscus, posterior cruciate ligament (PCL) angle, and PCL line. RESULTS: Bone bruise was observed in 35 cases (74.5%) at acute tear and in 9 (37.5%) at chronic tear, and mean PCL angle was 122 and 106 degrees, respectively. These two signs were significantly different (p<0.05) . The presence of posterior displacement of lateral meniscus was in 26 cases (55.3%) at acute tear and in 12 (50.0%) at chronic tear. Positive PCL line was in 23 (48.9%) and in 16 (66.7%) cases, respectively. CONCLUSION: Bone bruise, posterior displacement of lateral meniscus, PCL angle, and PCL line were helpful indirect signs suggesting an ACL tear in MR imagings. Posterior displacement of lateral meniscus and PCL line were not affected by the time of ACL tear. Bone bruise in acute tear and PCL angle in chronic tear were very frequent.

Influence of the Posterior Slope of the Tibial Component on the Maximal Flexion after Total Knee Arthroplasty

To evaluate the effect of tibial cut with posterior slope in total knee arthroplasty(TKA) surgery on the flexion of the knee, 41 knees(32 patients) with varying degree of the posterior slope were retrospectively reviewed at more than 1 year after operation. Does sloping the tibial cut iurface rnore posteriorly promote increasing of maximal flexion of the knee by elimination of excessive tenaion of the posterior cruciate liga ment The degree of the posterior slope was radiographically measured, awi the change of the degree of the maximal flexion between preoperative and postoperative period was clinimlly measured with a goniometer at the latest follow up more than 1 year after operation. Comparison of the results demonstrated significantly larger degree of rqaximal flexion for the knees that had tibial cut with the degree of the posterior slope, 5 degrees or rnore (p<0.05). We concluded that 5 degrees or more posterior slope in proxirnal tibial cut is one of the important fact()r which could achieve increased flexion of the knee after TKA operation.

MR Imaging of the Knee: Three-Dimensional Fourier Transform GRASS Technique

PURPOSE: To evaluate the usefulness of three-dimensional(3D) Fourier transform(FT) gradient refocused acquisition in steady state(GRASS) technique for MR imaging of the knee. MATERIALS AND METHODS : Sixty-three kneesin 61 patients were imaged on the 1.5T MR system. We compared 3DFT GRASS technique with 2D spin echo(SE) techniquein terms of conspicuousness of the lesions of internal knee structures based on the results of arthroscopy or open surgery. As a SE technique, sagittal T1-and T2-weighted, and coronal fat-suppressed T2-weighted sequences were performed. Sixty contiguous axial scans with 0.7 or 1mm section thickness were performed using 3D GRASS technique, and we also evaluated arbitrarily reformatted images produced from the original axial voxel images. RESULTS: For the depiction of the tear, 3DFT GRASS was superior to 2D SE in three cases of medial meniscus, one of later almeniscus, and two of anterior cruciate ligament. Specificity of 3D GRASS was also higher than that af 2D SE inevaluation of lateral meniscus and anterior cruiciate ligament. There was no significant difference in MR diagnosis for tears of the posterior cruciate, medial collateral, and lateral collateral ligaments. 3D GRASS was superior in evaluating the extent and morphology of the torn menisci. CONCLUSION: The 3DFT GRASS technique was comparable or even superior to the 2D SE technique in the evaluation of the internal structure of the knee, andcan be expected to supplement standard MR knee techniques, especially in complicated cases of meniscal orligamentous tears.

Clinical Evaluation of Complications of Interlocking Nail for Femoral Shaft Fracture / 대한정형외과학회잡지

The intramedullary nailing is one of the most available method in treatment of femoral shaft fracture. Since the development of Kuntscher naukl in 1940, new design such as Grosse-Kempf IM nailing became widely used by more applicable level of femoral shaft fracture. Therefore, complications of intramedullary nailing was rarely seen. The authors analysed complications in 7 cases of intramedullary nailing for treatment of femoral shaft fracture in Koryo General Hospital from Jan. 1991 to Jan. 1993., and the results were as follows; 1. The average age was 40.5 years and all patient's sex were male. 2. Among 7 cases, complications were delayed union in 4 cases, metallic failure in 2 cases and femoral neck fracture in 1 case. 3. Among 4 cases of delayed union, 3 cases treated by weight-bearing after dynamization and 1 case treated by bone graft after dynamization. 4. Metallic failure occurred in 2 cases, 1 case developed metallic corrosion in medullary canal, the other case developed metal failure at fracture. 5. Fomoral neck fracture in 1 case was treated by multiple Knowles' pins.