Treatment Outcomes of Triplane and Tillaux Fractures of the Ankle in Adolescence

BACKGROUND: To identify the fracture configuration and treatment results for patients with triplane and Tillaux fractures in the ankle joint. METHODS: A retrospective study was performed on 14 patients with a more than one year follow-up. This study investigated the fracture configuration, concomitant fibula fracture, treatment methods and complications. The treatment outcomes were analyzed using modified Weber protocol. RESULTS: Among the 14 cases, 11 were triplane fractures and 3 were Tillaux fractures. Seven were two part triplane fractures, and 4 were three part triplane fractures. Eight were lateral triplane fractures, and 3 were medial triplane fractures. A fibula fracture was accompanied by 7. The fibular fracture comprised of oblique fractures in all cases. A closed and open reduction was performed in 6 and 8 cases, respectively. All but one showed excellent treatment outcomes at the final follow-up. Traumatic arthritis developed in 1 case. CONCLUSIONS: Precisely detecting the fracture configuration by computed tomography and understanding the injury mechanism have greatly improved the outcomes of triplane fractures and Tillaux fractures of the ankle in adolescent patients.

Muscle Free Flap Transplantation in Chronic Osteomyelitis of the Lower Extremities

PURPOSE: To evaluate the result of muscle free flap transplantation in chronic osteomyelitis of the tibia and calcaneus occurred from open fractures and exposed bones and internal fixatives. MATERIALS AND METHODS: The free muscle flap were transferred in the tibia and calcaneus and followed up average 7.3 years at the department of orthopedic surgery from March 1997 to September 2009. Six patients were male and 1 case female averaged 50.3 years of age. Two latissimus dorsi myocutaneous free flaps were transplanted to the exposed 2/3 of the tibia with soft tissue defect, one rectus abdominis muscle free flap to the mid 1/3 of the tibia and four gracilis muscle free flaps to the distal 1/3 of the tibia and calcaneus. RESULTS: At average 7.2 years follow-up, all of the 7 cases obtained solid bone union in the X-ray and kept sound soft tissues without pus discharges. The overall result of bone union, healed soft tissues defect and normal knee and ankle joint range of motion were excellent. CONCLUSION: The free muscle flap transferred to the chronic osteomyelitis of the tibia and calcaneus showed excellent results in bone union and eradication of the pus forming bacteria by its abundant blood flow.

Factors Influencing Premature Physeal Closure following Physeal Injury of the Ankle in Children / 대한정형외과학회잡지

PURPOSE: To evaluate the factors influencing premature physeal closure (PPC) following physeal fractures of the ankle in children. MATERIALS AND METHODS: Forty-eight children with physeal injuries of the ankle were analyzed retrospectively after a minimum follow-up of 1 year. We undertook statistical analysis according to age, gender, cause, fracture type, mechanism of injury, and treatment methods for incidence of PPC. RESULTS: Ten fractures (28.3%) were complicated by PPC. There were three cases of leg length discrepancy (LLD) more than 2 cm, five cases of angulation with LLD more than 2 cm, and two cases of fibula shortening. There were no correlation between PPC and age, sex, cause, or injury mechanism (p>0.05). There was a statistically significant correlation between the rate of PPC and treatment methods (p=0.018). CONCLUSION: Operative treatment may decrease the frequency of PPC in some fractures. Regardless of treatment method, we recommend anatomic reduction to decrease the risk of PPC.

Periacetabular Osteotomy for Treatment of Acetabular Dysplasia through Iliofemoral approach

PURPOSE: To evaluate the clinical and radiologic results of periacetabular osteotomy, for treating acetabular dysplasia through iliofemoral approach. MATERIALS AND METHODS: We evaluated the results of 17 periacetabular osteotomies performed in 17 patients (12 female, 4 male). The osteotomies were performed through an iliofemoral approach in 17 hips. The mean age of the patients at the time of surgery was 34.7 years (range: 14~61 years). The average follow-up period was 26 months (range: 12~48 months). The D'Aubigine and Postel score was used for clinical evaluation. Radiological changes of acetabular head index, the CE angle (lateral and anterior), and the sharp angle were measured, respectively. RESULTS: Clinically, the mean D'Aubigine and Postel scores improved from 12.7 preoperatively to 15.1 postoperatively. All four radiological measurements improved significantly after surgery (Wilcoxon Rank Sum test: p< 0.05). The following complications were noted: posterior column fracture in 2 hips and peripheral nerve dysfunction was noted in 5 patients. Of these nerve palsy, lateral femoral cutaneous nerve palsy in 3 patients, 1 patient complained troublesome, transient sciatic nerve palsy and femoral nerve palsy in 1 patient. There were no vascular complications or heterotopic bone formation and conversion to total hip arthroplasty. CONCLUSION: Periacetabular osteotomy by the iliofemoral approach is an effective surgical treatment for acetabular dysplasia in adults, but should be careful nerve injuries.

Comparison of Posterior Lumbar Interbody Fusion with Posterolateral Fusionin Degenerative Lumbar Spinal Disorders / 대한정형외과학회잡지

PURPOSE: This study compared the surgical treatment results between posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) with pedicle screw fixation in degenerative lumbar spinal disorders. MATERIALS AND METHODS: In 45 cases of PLF (group I) and 45 cases of PLIF (group II), lumbar lordosis, segmental lordosis, bone union and complications were considered to be an evaluation criterion. Kim's functional evaluation scale was used for the clinical results. RESULTS: The average lumbar lordosis in group I was 36.84+/-8.31 degrees preoperatively, 40.58+/-7.61 degrees postoperatively and 35.73+/-7.61 degrees at the last follow up. On the other hand, the respective changes in the average lumbar lordosis were 31.53+/-7.09 degrees, 39.11+/-7.21 degrees, and 35.47+/-7.76 degrees in group II. Definitive solid union was obtained in 41 cases in group I (91.1%) and 43 cases in group II (95.6%). The rate of complications was 24.4% (11 cases) in group I and 2.2% (6 cases) in group II, and a satisfactory functional outcome were obtained in 43 cases (95.6%) in group I and 41 cases (91.1%) in group II. CONCLUSION: Both PLF and PLIF on short segment fusion provided satisfactory bone union and clinical results. In segmental lordosis, there were no significant differences between the two groups. However, PLIF was more effective in preventing lumbar lordosis and complications than PLF. A longer term follow up will be needed to evaluate the adjacent segmental degeneration and maintenance of the sagittal balance.

Metabolic Syndrome and Orphan Nuclear Receptor SHP / 대한내분비학회지

No abstract available.