Effect of Spine-Pelvis Relationship in Total Hip Arthroplasty / 대한고관절학회지

When spine-pelvic motion is normally coordinated, the pelvis may tilt posteriorly and acetabular anteversion may increase as the patient's position changes from standing to sitting; this scenario allows for improved clearance of the femoral head and neck during hip flexion. However, changes in the mobility of the spine and pelvis may result in impingement after total hip arthroplasty (THA), with the most obvious complication being dislocation. Understanding the spinal-pelvic relationship in the sagittal plane is essential for planning THA in patients with spinal fusion or a known spine disease. Careful attention should be payed to the cup position when performing THA on patients with an increased risk of dynamic impingement.

Result of Staged Operation in Ruedi-Allgower Type II and III Open Tibia Pilon Fractures with Severe Comminution / 대한족부족관절학회지

PURPOSE: This study analyzed the clinical and radiological results of Reudi-Allgower type II and III open tibia pilon fracture patients who underwent plate fixation after the recovery of a soft tissue injury after external fixation. MATERIALS AND METHODS: From 2010 to 2015, this study analyzed 14 patients who were treated for open tibial pilon fractures and could be followed up at least one year. The mean age was 49 years and the average follow-up period was 19 months. An emergency operation was performed for external fixation and open wounds, and secondary surgery was performed for definitive fixation using a plate. The radiological and clinical evaluations were analyzed retrospectively. Complications, such as post-traumatic osteoarthritis and wound infections were also analyzed. RESULTS: The mean duration between two-staged surgery was 21 days and the mean bone union time was 9.2 months. Three cases of delayed union and one case of nonunion were reported. The malunion did not occur in all cases. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 68 points. A limitation of the ankle motion occurred in all cases. In four cases, wound infections due to initial open wounds occurred; one patient underwent a below the knee amputation due to chronic osteomyelitis. Post-traumatic arthritis occurred in 10 cases. CONCLUSION: Severe comminuted tibial plateau open fractures of Reudi-Allgower type II and III, which are high-energy injuries that result in extensive soft tissue damage, have a higher incidence of complications, such as ulcer problems and osteomyelitis, than closed tibia plateau fractures. Post-traumatic arthritis is the most common complication of tibia plateau open fractures, and staged surgery is recommended because of the relatively satisfactory clinical results.

Management of High Ankle Sprain / 대한족부족관절학회지

High ankle sprain (distal tibiofibular syndesmosis injury) occurs from rotational injuries, specifically external rotation, and may be associated with ankle fractures. The prevalence of these injuries may be higher than previously reported because they may be missed in an initial examination. Syndesmosis injury can lead to significant complications in injured ankle joints, so a precise physical examination and radiological evaluation is necessary. The most important treatment goal is to have the tibia and fibula located in the correct position with respect to each other and to heal in that position. The methods to fix these injuries is controversial.

The Risk Factors Associated with Nonunion after Surgical Treatment for Distal Fibular Fractures / 대한족부족관절학회지

PURPOSE: The purpose of this study was to evaluate the radiologic outcomes of distal fibular fractures and to analyze the risk factors associated with nonunion. MATERIALS AND METHODS: Between January 2009 and March 2016, 13 patients who had final nonunion with ankle fracture were included. In the control group, 370 patients who had undergone bony union and removed metal implants were included. All patients underwent the same surgical procedure and had the same treatment method, ultimately achieving satisfactory open reduction results with less than 2 mm fracture gap. Surgical treatment of fracture was considered to have the same effect on nonunion, and factors that might be associated with nonunion were evaluated. SPSS ver. 13.0 (SPSS Inc., USA) was used for all statistical analyses. Pearson's chi-square test and multi-variate regression analysis were performed to determine the factors affecting nonunion of distal fibular fracture. A p-value less than 0.05 was considered statistically significant, and relative risk was assessed. RESULTS: The mean age of 13 patients was 46.9 years (range, 16~57 years); there were 8 men and 5 women. Among the 13 patients with nonunion, atrophic was the most common (12 cases). The association between the injury mechanism and the Lauge-Hansen classification and diabetes mellitus was not statistically significant. Distal fibular fractures with tibia shaft fracture (p=0.015) and Danis-Weber type C fracture (p=0.023), open fracture (p=0.011), and smoking (p=0.023) were significantly associated with nonunion. CONCLUSION: In this study, the combined injury of the ipsilateral tibia shaft fracture, open fracture, and Danis-Weber type C fracture may increase the possibility of nonunion. Therefore, caution is advised to prevent nonunion.

Interlocking Intramedullary Nailing for Far Distal Tibia Fractures in AO Classification 43 / 대한정형외과학회잡지

PURPOSE: This retrospective study was conducted in order to evaluate the results of interlocking intramedullary nailing of far distal tibia fractures located within AO classification 43. MATERIALS AND METHODS: Seventy patients with far distal tibia fractures in AO classification 43 treated with interlocking intramedullary nailing from May 2008 to April 2012 were evaluated. The minimum follow-up period was 12 months. We analyzed preoperative fracture pattern, associated injury, and complication. All cases were treated with use of either two or three distal interlocking screws during intramedullary nailing. Patients received regular post-operative radiographic check-up and ankle function was evaluated using the Iowa ankle-evaluation rating system. RESULTS: The fractures healed completely within an average of 18 weeks. None of the patients showed malaligment on the final radiographic evaluation. Average of varus-valgus aligment was 1.9 degrees and average of anterior-posterior alignment was 1.1 degrees. According to the Iowa ankle-evaluation rating system, we obtained satisfactory clinical results in 14 cases. Complication occurred in two cases. There was one case of hypertrophic nonunion and one breakage of the distal locking screw with delayed union. CONCLUSION: We consider that interlocking intramedullary nailing of far distal tibia fractures located within AO classification 43 is a considerable method when a plate is not used due to accompanying severe open wound, etc. For satisfactory results, accurate technique and experience of the operator were required.

Arthroscopic Assisted Intra-Articular Reduction and Internal Fixation of Tibia Plateau Fracture

PURPOSE: We evaluated the results of arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window along with any additional bone grafts. MATERIALS AND METHODS: From March 2006 to March 2009, twelve patients with arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures over 5 mm in depression and displacement on the articular surface in computed tomography (CT) were enrolled in this study. We reduced or removed the depressed fracture fragment using freer without making a cortical window. Then, we accomplished internal fixation by a cannulated screw. All cases have not received bone graft. Both the postoperative clinical and radiological results were evaluated by the Rasmussen system. RESULTS: The fractures were healed completely in an average of 9 (range from 7 to 12) weeks. According to Rasmussen classification, we obtained satisfactory clinical results as excellent in 8 cases, good in 3 cases, and fair in 1 case; and radiological results were excellent in 7 cases and good in 5 cases. CONCLUSION: We consider that arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window and any additional bone grafts is are a useful methods for attaining satisfactory results.