Transarticular Fixation of Akin Osteotomy on Patients with Hallux Valgus after Resection of Medial Protrusion of Base of Proximal Phalanx / 대한족부족관절학회지

PURPOSE: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, it could lead to skin irritation and medial pain after the surgery. The purpose of this paper was to report our clinical and radiographic results with transarticular fixation of Akin osteotomy for the treatment of patients with hallux valgus after resection of the medial protrusion of base of the proximal phalanx. MATERIALS AND METHODS: Our study is subject to 34 cases of 30 patients who went through proximal phalanx medial corticectomy among patients undergone both hallux valgus surgery and Akin osteotomy at our institution from March 2006 to March 2012. In all cases, we used absorbable suture material through the articular surface for Akin osteotomy after resection of the medial protrusion in proximal phalanx. Radiographs were reviewed to assess the union and displacement of osteotomy site at the time of postoperative 6 months. The clinical results were assessed by using AOFAS score and complication such as skin irritation and pain. RESULTS: AOFAS score was improved from average 44 points(36-58), before operation and average 87 points(74-96), 12 months after operation. In two cases, partial union was suspected in radiological perspective, however, complete union on the osteotomy site was observed in all cases, 12 months after the operation. No patients was dissatisfied with pain, joint discomfort, skin irritation and inflammation from the knot. CONCLUSION: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, We have good results by transarticular fixation of Akin osteotomy using absorbable suture material.

The Comparison of Minimally Invasive Percutaneous Plate Osteosynthesis versus Open Plate Fixation in the Treatment of in the Distal Femur Fracture

PURPOSE: To evaluate the efficacy of surgical treatment through retrospective comparison of minimally invasive percutaneous plate osteosynthesis (MIPPO) vs open plate fixation in the treatment of the distal femur fractures. MATERIALS AND METHODS: Thirty-one patients with distal femur fractures from January 2002 to December 2010 were divided into two groups depending on the surgical method. Minimum follow up was 12 months. Group A consisted of 17 patients treated with MIPPO, and group B was comprised of 14 patients treated with open plate fixation. Clinical outcomes including operation time, transfusion rate, rehabilitation, range of motion, and interval change of postoperative C-reactive protein (CRP) were evaluated to assess postoperative inflammatory reaction, postoperative complications and clinical results with the use of Sanders criteria. RESULTS: The operative time was 86/135 min and transfusion volume was 0.8/1.9 unit respectively. The postoperative 3-day and 7-day CRP were 7.4/1.5 mg% in group A and 10.3/2.4 mg% in group B, showing more minimal tissue injury and early recovery in group A. There were no significant differences in clinical results by Sanders criteria in both groups. CONCLUSION: Both MIPPO and open plate fixation for the treatment of distal femur fractures showed comparably good results. However, the MIPPO technique is superior to group B in view of minimal tissue injury and operation time and was proven to lessen the transfusion rate.

Analytic Study of the Clinical Features of Korean Juvenile Rheumatoid Arthritis (JRA) / 대한류마티스학회지

OBJECTIVE: To investigate the clinical characteristics of Korean JRA and the possible profiles related to prognosis and to compare these data to pre-existing occidental reports. METHODS: 140 cases of JRA patients were randomly selected from 1986 through 1995. Juvenile ankylosing spondylitis was excluded with the aid of modified New York criteria for ankylosing spondylitis. We used the classification of progression of rheumatoid arthritis (radiological stage III+IV / I+II+III+IV) as a index of prognosis. The study factors were sex, age, type, affected joints, degree of destruction of joint, anti-nuclear antibody (ANA), rheumatoid factor (RF), HLA-B27 and extra-articular manifestations. Chi-square test, One-way ANOVA test, and Pearson' s correlation coefficient were used as statistical methods. RESULTS: Our study show results as follows : (1) Systemic onset type (ll%) { polyarthritis subset (66%), oligoarthritis subset (34%) }, oligoarthritis onset type (62%) { sero (-) -HLA-B27 (+) subset (66%) , RF (+) subset (20%), not otherwise classified subset (14%) ANA(+)-chronic uveitis subset(O%) }, polyarthritis onset type (27%) { RF(+) subset (66%), not otherwise classified subset (34%) }, (2) Sex ratio was M:F=1.8:l. (3) Age of onset was 11+3.6 years. (4) Affected joints were knee, ankle, hand in decreasing order of frequency. (5) Patients show seropositivity of RF in 31%, HLA-B27 in 54%, ANA in 8%. (6) Chronic uveitis was observed in 7 cases (5%) (all oligoarthritis onset type, M:F=6:1, age of onset 11+4.3 years, ANA (0%), HLA-B27 (86%) , 2 cases leading to blindness. (7) Destructive bone change was significantly more prominent in female (p<0.01) , RF(+) (p<0.01), HLA-B27(-) (p<0.01) , polyarthritis onset type (p=0.02). CONCLUSIONS: In this study, we obtained interesting results that are somewhat different from Occidental data in sex ratio (male dominance), age of onset (older age) , profiles of HLA-B27 (high positivity in spite of low HLA-B27 positivity in Korean (about 2. 3%) , low rate of destructive change) , ANA (low positivity, older age of onset) , chronic uveitis (low incidence, male dominance, older age of onset, high association with HLA-B27, not associated with ANA) . This study suggests possible racial difference in clinical features of JRA. But for prove of racial difference, further multi-center trial and large scale epidemiological study should be done.