Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients

BACKGROUND: Bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients is a viable option that can prevent the complications of an open reduction, such as nonunion and metal failure. This study evaluated the clinicoradiological results of cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients. METHODS: Forty hips were followed for more than 2 years after cementless bipolar hemiarthroplasty using a Porocoat(R) AML Hip System. The mean age was 78.8 years and the mean follow-up period was 40.5 months. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using a range of indices. RESULTS: At the last follow-up, the mean Harris hip score was 80.6 points. There were one case of hip pain and one case of thigh pain. Twenty-four cases (60%) showed no decrease in ambulation capacity postoperatively. Radiologically, there were 23 cases (57.5%) of fixation by bone ingrowth and 17 cases (42.5%) of stable fibrous fixation. There were no cases of osteolysis. Eleven cases (27.5%) of new bone formation were found around the stem. All stems were stable without significant changes in alignment or progressive subsidence. CONCLUSIONS: The short-term results of cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures were satisfactory.

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.

Overgrowth Following TibialShaft Fractures in Children / 대한정형외과학회잡지

PURPOSE: To assess the comparative growth of the four long bones of the lower extremities after the tibial shaft fractures in children. MATERIALS AND METHODS: Thirty-eight children (age, 8.2+/-2.6) with tibial shaft fractures treated with a closed reduction and a long leg cast were enrolled in this study. The mean follow-up was 54.4 months (range, 24-96). The medical records and Bell-Thompson images were retrospectively reviewed. RESULTS: The clinical results were excellent in all cases. The fractured tibia showed overgrowth (4.4+/-3.3 mm) compared with the contralateral side. The ipsilateral femur showed mild over-growth (0.9 mm+/-3.7), and the final leg length discrepancy was 5.3 mm+/-5.4. Four ipsilateral femurs showed overgrowth >10 mm. Gender, the level of the fractures and associated fibular fractures did not affect the overgrowth of the fractured tibia (p>0.05). However, age might affect the amount of overgrowth (p=0.005). CONCLUSION: Tibial shaft fractures in children treated with a long leg cast showed variable overgrowth. The final leg length discrepancy was influenced by the overgrowth of the ipsilateral femur as well as by overgrowth of the tibia.