Comparison of a Cryopneumatic Compression Device and Ice Packs for Cryotherapy Following Anterior Cruciate Ligament Reconstruction

Background@#The purpose of the current study was to evaluate and compare the effectiveness of a cryopneumatic compression device with that of standard ice packs following arthroscopic anterior cruciate ligament (ACL) reconstruction, with a primary focus on early postoperative pain. @*Methods@#Participants were divided into two groups: cryopneumatic compression device group (CC group) and standard ice pack group (IP group). Patients in the CC Group (28 patients) received a cryopneumatic compression device (CTC-7, Daesung Maref) treatment, while patients in the IP group (28 patients) received standard ice pack cryotherapy postoperatively. All cryotherapy was applied three times (every 8 hours) per day for 20 minutes until discharge (postoperative day 7). Pain scores were assessed preoperatively and at 4, 7, and 14 days after surgery, and the primary outcome for analysis was pain at postoperative day 4 assessed using a visual analog scale (VAS). Other variables were opioid and rescue medication use, knee and thigh circumferences, postoperative drainage, and joint effusion quantified by a three-dimensional magnetic resonance imaging (MRI) reconstruction model. @*Results@#The mean pain VAS score and difference in VAS relative to the preoperative measurements for postoperative day 4 were significantly lower in the CC group than in the IP group (p = 0.001 and p = 0.007, respectively). The sum of postoperative drainage and effusion quantified by MRI showed a significant reduction of postoperative effusion in the CC group compared to the IP group (p = 0.015). The average total rescue medication consumption was comparable between the two groups. Circumferential measurements at days 7 and 14 postoperatively relative to those at day 4 (index day) demonstrated no significant differences between the groups. @*Conclusions@#Compared to standard ice packs, application of cryopneumatic compression was associated with a significant reduction in VAS pain scores and joint effusion during the early postoperative period following ACL reconstruction.

Outcomes of Angular Stable Locking System in Femoral Diaphyseal Fractures of Elderly Patients:A Multicenter Comparative Study

Background@#The angular stable locking system (ASLS) was developed to provide additional stability to the distal interlocking screw of the intramedullary (IM) nail. Effects of ASLS on the treatment of femoral diaphyseal fractures in the elderly remain unknown. The aim of this study was to compare radiological outcomes of IM nailing using ASLS screws to IM nails with conventional interlocking screws in elderly patients with femoral shaft fractures. @*Methods@#A multicenter retrospective review of 129 patients (average age, 73.5 years; 98 women and 31 men) aged 65 years or older who underwent IM nail fixation for femoral diaphyseal fractures (AO/Orthopaedic Trauma Association [OTA] classification 32) was conducted. Demographic information of patients, fracture site (subtrochanteric or shaft), fracture type (traumatic or atypical), and AO/OTA fracture classification were investigated. Reduction status was evaluated by postoperative plain radiography. Presence of union and time to union were evaluated through serial plain radiograph follow-up. Reoperation due to nonunion or implant failure was also evaluated. @*Results@#ASLS was used in 65 patients (50.3%). A total of 118 patients (91.5%) achieved union without additional surgery and the mean union time was 31.8 ± 13.0 weeks. In terms of reduction status, angulation was greater in the group using ASLS. There were no statistically significant differences of union rate, time to union, and reoperation rate according to the use of ASLS (p > 0.05). There was no difference in the outcomes according to the use of ASLS even when the analysis was divided in terms of fracture site or fracture type (p > 0.05). In further subgroup analysis, only the traumatic subtrochanteric area group showed statistically significantly shorter time to union when ASLS was used (p = 0.038). @*Conclusions@#In geriatric patients with femoral diaphyseal fractures, the use of ASLS was not considered to have a significant effect on fracture healing. Fracture healing seemed to be more affected by surgical techniques such as minimizing the gap and fracture characteristics such as atypical femoral fractures, rather than implants.

Spino-Pelvic Fixation in Unstable Sacral Fracture: A Case Report

A 22-year-old female patient visited the emergency room (ER) after a pedestrian traffic accident in a drunken state. An examination at the ER revealed fractures at the right side of the sacral ala, sacral foramina, left anterior acetabulum, right inferior ramus, and right superior articular process of S1. She underwent spino-pelvic fixation and iliosacral (IS) screw fixation. One year later, bone union was completed and implant removal was performed and the treatment was completed without complications. The authors recommend spino-pelvic fixation and IS screw fixation for unstable sacral fractures as one of the excellent methods for obtaining posterior stability of the pelvis among the various treatments of unstable sacral fractures.

Comparative Analysis of (99m)Tc-MDP Three-Phase Bone Scan with SPECT/CT and (99m)Tc-HMPAO-Labeled WBC SPECT/CT in the Differential Diagnosis of Clinically Suspicious Post-traumatic Osteomyelitis / 대한핵의학회잡지

PURPOSE: To identify differences between three-phase bone scan and SPECT/CT (TBS) and WBC SPECT/CT (WS) and compare diagnostic accuracies of each modality in patients with suspicious post-traumatic osteomyelitis (OM).METHODS: Twenty-one patients with suspicious post-traumatic OM were enrolled. All patients performed TBS and WS within 1 week. Foci ofMDP andWBC accumulation were divided into three categories: bone (OM), soft tissue (soft tissue inflammation; STI), negative for inflammation (NI). Confirmative diagnosis was made upon operative pathology or long-term clinical follow-up.RESULTS: Of 21 patients, four OM, eight STI, nine NI were finally diagnosed. TBS diagnosis was correct in three of four positive cases and nine of 17 negative cases. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) of TBS were 75 %, 52.9 %, 57.1 %, 27.3 %, 90 %. WS diagnosis was correct in two of four positive cases and 17 of 17 negative cases. Sensitivity, specificity, accuracy, PPV, NPV were 50 %, 100 %, 81.0 %, 100 %, 89.5 %. Twelve of 21 cases showed agreement between TBS and WS. TBS misdiagnosed nine cases (six STI and two NI as eight OM; one OM as one STI), while WS misdiagnosed four cases (two OM as two STI; two STI as two NI). Combining results from TBS and WS led to better diagnostic accuracy (91.7 %) than either TBS or WS alone.CONCLUSION: TBS and WS showed moderate agreement in assessment of clinically suspected post-traumatic OM. WS better evaluated inflammation than TBS. WS tended to underestimate inflammation whereas TBS tended to overestimate inflammation. Combining TBS and WS enhanced diagnostic accuracy.

Risk Factors Associated with Dislocation after Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture / 대한고관절학회지

PURPOSE: We investigated the incidence and time of dislocation and other factors associated with dislocation of bipolar hemiarthroplasty related to the treatment of femoral neck fracture in old age patients. MATERIALS AND METHODS: Between January 2002 and April 2014, 498 femoral neck fractures (467 patients) were treated with bipolar hemiarthroplasty and included in this study. All surgeries were performed using the postero-lateral approach. The incidence of dislocation was investigated. A comparative analysis between a control group and dislocation group was performed with respect to patient factors including age, gender, body mass index, comorbidities, the ASA (American Society of Anesthesiologists) score, mental status and center-edge angle, and surgical factors including type of femoral stem, leg length discrepancy, femoral offset and method of short external rotator (SER) reconstruction. RESULTS: The incidence of dislocation was 3.8%, and the dislocation occurred on average 2.2 months (range, 0.6-6.5 months) after operation. No difference in patient-related factors was observed between the two groups. However, a smaller center edge (CE) angle was observed in the dislocation group (42.1°±3.2° vs. 46.9°±5.4°, P<0.001), and significantly lower incidence of dislocation was observed in tendon to bone repair group (0.7% vs 7.8%, P<0.001). CONCLUSION: SERs should be repaired using the tendon-to-bone repair method to reduce dislocation rate in elderly patients who undergo bipolar hemiarthroplasty using the postero-lateral approach due to femoral neck fracture. In addition, patients with smaller CE angle should be carefully monitored due to high incidence of dislocation.

The Comparison of Compression Hip Screw and Bipolar Hemiarthroplasty for the Treatment of AO Type A2 Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: The purpose of this study was to compare the outcomes of osteosynthesis using compression hip screw fixation versus bipolar hemiarthroplasty in AO type A2 intertrochanteric fractures. MATERIALS AND METHODS: From March 2003 to December 2009, 89 patients were included in this study. They were treated using compression hip screws (43 cases) or bipolar hemiarthroplasty (46 cases). The mean age of patients was 77.7 years (65-94 years) and the mean follow-up period was 5.9 years (1-8.3 years). For comparison of the outcomes in the two groups, statistical analyses were performed with parameters including anesthesia time, operation time, amount of transfusion, hospital stay, general complications, clinical outcome, time of partial weight-bearing using a walker, and radiological failure rate. RESULTS: Differences in the amount of transfusion, general complications, and clinical outcome (Merle d'Aubigne and Postel score) were not statistically significant between the two groups. The bipolar hemiarthroplasty group showed better results than the compression hip screw group for anesthesia time and the time of partial weight-bearing using a walker. Radiological failures were observed in hips in one case (2.2%) of bipolar hemiarthroplasty, and in four cases (9.3%) of compression hip screw fixation. CONCLUSION: Among elderly individuals with AO type A2 intertrochanteric fractures, patients treated with bipolar hemiarthroplasty were able to perform early ambulation. However, no significant difference in operation time, amount of postoperative transfusion, clinical results, hospital stay, and radiological failure rate was observed between the bipolar hemiarthroplasty and compression hip screw fixation groups.

Augmentative Locking Plate Fixation for the Treatment of Femoral Nonunion after Intramedullary Nailing

PURPOSE: To evaluate the efficacy of the augmentative locking compression plate fixation in the treatment of femoral shaft nonunion occurring after intramedullary nailing. MATERIALS AND METHODS: Between July 2004 and September 2012, a total of 17 patients (twelve men, five women, average age 52.5 years) who had femoral nonunions after primary intramedullary nailing for femoral shaft fractures were reviewed. The mean period of nonunion after primary nailing was 18.5 months. Leaving the nail in situ, an augmentative locking plate was applied to the nonunion site with simultaneous autogenous bone grafting, except for five hypertrophic nonunions. We followed up all patients with plain radiograph and evaluated clinical status to determine bone union. RESULTS: All patients demonstrated evidence of fracture union with an average follow-up time of 5.0 (range 2 to 9) months. The time of operation was an average of 115 (range 45 to 160) minutes, and mean blood loss was 345.9 (range 150 to 700) ml. Two patients noted discomfort at the distal portion of plate, and one noted discomfort of donor site, but functional limitation was not observed in all patients. CONCLUSION: Augmentative locking plate fixation for diaphyseal femoral nonunion after intramedullary nailing is a reasonable treatment option with increased stability.

Cementless Total Hip Arthroplasty Using the ABG I Hydroxyapatite-coated Prosthesis: Minimum 10 Year Follow-up / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) with an ABG I hip prosthesis after a minimum ten-year follow up. MATERIALS AND METHODS: From January 1996 to March 2001, 121 hips in 104 patients, whi were followed up for a minimum of ten-years, were enrolled in this study. The clinical and radiographic outcomes were evaluated and Kaplan-Meier survival analysis was performed. RESULTS: The mean Harris hip score at the last follow-up was 84 points. A radiolucent line around the cup, osteolysis, and cup loosening were observed in 5 hips(4.1%), 53 hips(43.8%), and 5 hips(4.1%), respectively. In the femoral side, osteolysis and stem loosening were observed in 11 hips(9.1%) and 2 hips(1.7%), respectively. The mean linear wear rate of the polyethylene liner was 0.23 mm/yr. Forty four revisions(36.3%) were performed. The outcomes were similar regardless of the cause of primary THA. The survival rate with the end point of revision due to cup loosening was 56.3%, and revision due to stem loosening was 98.1% after a 16 year follow-up. CONCLUSION: High polyethylene wear and the disappointing survival rate of the ABGI cup were observed after a minimum ten year follow-up. Therefore, close observation of patients who have received an ABG I prosthesis is necessary.

Reconstruction of a Severely Crushed Leg with Interpositional Vessel Grafts and Latissimus Dorsi Flap

We present a case of a near total amputation at the distal tibial level, in which the patient emphatically wanted to save the leg. The anterior and posterior tibial nerves were intact, indicating a high possibility of sensory recovery after revascularization. The patient had open fractures at the tibia and fibula, but no bone shortening was performed. The posterior tibial vessels were reconstructed with an interposition saphenous vein graft from the contralateral side and a usable anterior tibial artery graft from the undamaged ipsilateral distal portions. The skin and soft tissue defects were covered using a subatmospheric pressure system for demarcating the wound, and a latissimus dorsi myocutaneous free flap for definite coverage of the wound. At 6 months after surgery, the patient was ambulatory without requiring additional procedures. Replantation without bone shortening, with use of vessel grafts and temporary coverage of the wound with subatmospheric pressure dressings before definite coverage, can shorten recovery time.

Cementless Bipolar Hemiarthroplasty of Hip Fracture in Patients on Hemodialysis / 대한고관절학회지

PURPOSE: This study analyzed the clinical and radiologic results and complications in patients with chronic renal failure who underwent cementless bipolar hemiarthroplasty for treatment of hip fractures. MATERIALS AND METHODS: Between January 2003 and February 2010, we performed 36 consecutive cementless bipolar hemiarthroplasty procedures in 35 patients with hip fracture who were on hemodialysis for chronic renal failure. Clinically, postoperative Harris hip score, inguinal and thigh pain, and orthopaedic and medical complications were investigated. Radiologically, we examined bone ingrowth, osteolysis, loosening, and nonunion. RESULTS: According to the Harris hip score grading system, the average postoperative score was 85.7 and the function before the injury was restored in 29 cases. Postoperatively, four patients experienced mild inguinal pain and four patients experienced mild thigh pain. One patient experienced severe thigh pain. Orthopaedic complications(6 cases, 16.7%) included mild hematoma(3 cases), superficial wound infection(2 cases), and dislocation(1 case). Medical complications(10 cases, 27.8%) included sepsis(5 cases), multiple organ failure due to aggravation of underlying diseases(2 cases), ulcer perforation(2 cases), and aspiration pneumonia(1 case). Five patients had died within one year (mortality, 13.9%). Except for loosening of the femoral stem in one case, bone ingrowth was observed in all cases. None of the patients had osteolysis and nonunion. CONCLUSION: Although cementless bipolar hemiarthroplasty was considered as an effective treatment in patients with hip fractureon hemodialysis due to favorable results at midterm follow-up, close attention for the postoperative medical complications due to poor general condition is needed.

Humerus Shaft Fractures in Leisure Sport 'Flyfish Riding': 4 Cases Report

A fracture of the humeral shaft can occur by direct or indirect injury. Most occur as a result of direct injury mechanisms such as falls from a height, direct blows, and traffic accidents. Recently, the population enjoying watersports for leisure is increasing and 'flyfish riding', in which passengers ride an inflatable raft drawn by a motorboat, may cause humeral shaft fracture as twisting and axial compression forces occur on the humeral shaft while boarding. Accordingly, the incidence of humeral shaft fracture is expected to increase as more people are expected to enjoy leisure sport activities such as 'flyfish riding'. We report 4 cases of humeral fracture that occurred during this activity in the year 2011.

Treatment of Periprosthetic Femoral Fractures after Hip Arthroplasty

No abstract available.

The Third Generation Alumina-on-Alumina Bearing Total Hip Arthroplasty in Patients Under the Age of Forty: A Minimum Five-Year Follow Up Study / 대한정형외과학회잡지

PURPOSE: We investigated the results of the third generation alumina on alumina bearing total hip arthroplasty in patients under the age of forty. MATERIALS AND METHODS: Fifty patients (57 hips) under the age of forty, who had uncemented total hip arthroplasty using third generation alumina bearing, between April 2000 and March 2006 were observed. The group consisted of 24 men and 26 women. The average age at the operation was 30.3 years (18-39 years). The average follow up period was 8.0 years (5-11 years). The most common cause for surgery was rheumatoid arthritis. We assessed the clinical and radiological results and postoperative complications. RESULTS: The mean Harris hip score at the last follow-up was 96 points on average. There was no inguinal pain. However, there were two hips of which the patient was experiencing thigh pain. One hip with squeaking was observed. We could observe the stable bony fixation of implants in all hips. There were no aseptic loosening and no osteolysis around the implants. Postoperative complications included one hip with nonunion of trochanteric osteotomy and one hip with dislocation. There were no ceramic fractures, no postoperative infections and no revisions. CONCLUSION: We observed the favorable clinical and radiographic outcomes of the third generation alumina on alumina total hip arthroplasty in patients under the age of forty. However, in the case of squeaking, a longer term follow-up is needed.

Revision Total Hip Arthroplasty of an Acetabular Cup with Acetabular Bone Defects

Recently, the incidence of revision total hip arthroplasty (THA) has increased following primary THA. Bone stock deficiency presents the major challenge in acetabular reconstruction during revision hip arthroplasty. The reasons for such acetabular defects include osteolysis, bone resportion following cup loosening, iatrogenic damage resulting from cup or cement removal during revision THA, and cup migration. The pre-operative assessment of acetabular bone stock, including the amount and location of pelvic osteolysis before revision surgery, is a critical preoperative preparation for the treatment of bone deficiency. In cases with mild acetabular defects, a variety of surgical options are available for treating. However, in cases with severe segmental, cavitary, or combined acetabular defects, controversies have existed so far about the most optimal treatment. Thereby, we tend to introduce the most commonly-adopted classification system of acetabular defects and management options using high hip center cups, oblong cups, structural allografts, morselized allografts with bipolar cups, morselized allografts with cementless cups, morselized allografts with acetabular reinforcement devices, and revisions with trabecular metal augmentations.

Risk Factors for Dislocation after Primary Total Hip Arthroplasty with the Transtrochanteric Approach

PURPOSE: We wanted to evaluate the risk factors that predispose a patient to dislocation after undergoing primary total hip arthroplasty with the transtrochanteric approach. MATERIALS AND METHODS: Between July 1995 and May 2007, 593 consecutive total hip arthroplasties using the trantrochanteric approach were performed. A matched comparative study was performed for the dislocated group(18 hips) and the non-dislocated control group(18 hips). The patient-related factors and mechanical factors were retrospectively reviewed to evaluate the risk factors for dislocation. RESULTS: Dislocation occurred in 18 hips(3.04%). The mean age was 57.1 years in the dislocated group and 55.2 years for all of the patients (p>0.05). Statistical analyses of the BMI, inclination and anteversion of the cup, lowering of the hip center, a leg length discrepancy, the size of the femoral head and nonunion of the greater trochanter revealed no significant differences between the two groups. Nonunion of the greater trochanter was observed in 16 hips(2.84%). The risk of dislocation was 8.5 times higher in the patients with excessive alcohol intake (p<0.05). The combination of more than 3 risk factors significantly affected the incidence of dislocation after total hip arthroplasty (p<0.05). CONCLUSION: After primary total hip arthroplasty with the transtrochanteric approach, in the cohort of this study, excessive alcohol intake was the main risk factor for dislocation and a combination of risk factors contributed to dislocation.

Revision Total Hip Arthroplasty Using a Wagner Revision Stem

PURPOSE: We evaluated the results of revision total hip arthroplasty using a Wagner revision femoral stem. MATERIALS AND METHODS: We enrolled 54 patients who underwent hip arthroplasty using a Wagner revision stem between 1996 and 2004. The mean age at revision surgery was 65.4 years and the mean follow up period was 7.2 years. There were 42 aseptic loosenings and 12 periprosthetic fractures. The pre-operative femoral defects were classified according to the Paprosky classification system. Clinical and radiological results were evaluated. RESULTS: The mean Harris hip score improved from 43 preoperatively to 89 at the latest follow up. There were 2 cases with inguinal pain and 1 with thigh pain; in each case pain was reduced by medications. All cases showed endosteal bone formation around the stem. Five cases showed radiolucency in Gruen zones 1 and 7. Six cases had hips that showed subsidence (average=3.1 mm). There was 1 dislocation (1.8%) and 1 intraoperative periprosthetic fracture (1.8%). There were no re-revisions. CONCLUSION: Use of a Wagner revision femoral stem for revision total hip arthroplasty elicits satisfactory results including stable fixation of the stem, a low rate of subsidence, and a low rate of dislocation.

The Efficacy of a Periarticular Soft Tissue Injection of Bupivacaine and Morphine in Total Hip Arthroplasty: a Prospective Study

PURPOSE: We wanted to assess the benefits and safety of periarticular soft tissue injection of bupivacaine and morphine in total hip arthroplasty by conducting a prospective randomized trial. MATERIALS AND METHODS: Between February 2008 and January 2010, a prospective, randomized study was performed on fifty patients with an American Society of Anesthesiology stage of I or II. All the patients were administered COX-2 inhibitor and we used PCEA (Patient Controlled Epidural Analgesia) for 24 hours postoperatively. All the patients underwent their operation under general anesthesia. Fifty randomly selected patients were divided into two groups. After reduction of the hip joint, 50 ml of normal saline was intraoperatively injected into 25 patients (Group A) and 50 ml of locally injected analgesia that included 0.5 ml 5 mg of morphine HCL, 40 ml of 0.5% 50 mg chirocaine (Levo-bupivacaine) and 9.5 ml of normal saline was injected into the capsule and the soft tissue and muscle around the hip joint in 25 patients (Group B). The analgesic efficacy was evaluated by the visual analogue scale (VAS) at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and during a passive exercise (30degrees) state. The consumption of PCEA and additional analgesic drugs was also evaluated postoperatively. RESULTS: Significant differences were found between the 2 groups (P0.05). CONCLUSION: Intraoperative periarticular soft tissue injection of bupivacaine and morphine can significantly reduce pain and it can reduce the requirement for patient-controlled analgesia, with no apparent risks, following total hip arthroplasty.

Persistency and Change of the Bone Mineral Density with Alendronate Treatment after Hip Fracture

PURPOSE: The purpose of this study was to evaluate the effects of alendronate on bone mineral density (BMD) and to determine the persistency and side effects of alendronate treatment after hip fractures. MATERIALS AND METHODS: 452 patients who underwent surgery for hip fractures from March 2000 to February 2007 were retrospectively included. The hip fractures consisted of 218 cases of femur neck fractures and 234 cases of intertrochanteric fractures. There were 254 women and 198 men with a mean age of 73.4 years (range: 60~95 years) at the time of surgery. The BMD was assessed in 398 patients and 348 were diagnosed with osteoporosis, while 102 received alendronate for treatment. The persistency with alendronate treatment and change of the BMD were evaluated annually. We also evaluated the side effects and reasons for discontinuation. RESULTS: The prescription rate of alendronate was 29.3% and the persistency rate over 1 year was 33%. The annual BMD of the lumbar spine showed a 9.11% increase the first year, a 4.5% increase the second year and a 3.5% increase the third year, while negative changes were noted in the proximal femur as a 1.89% decrease the first year, a 1.38% decrease the second year and a 0.97% decrease the third year. The BMD changes were 11%(L: Lumbar spine) and 1.1%(F: Femur) for the T-scores -3.0, respectively. The BMD changes in the patients with femur neck fractures and who were treated with hemiarthroplasty were 15.6%(L) and -3.9%(F). The BMD changes in the patients with intertrochanteric hip fractures and who were treated with compression hip screws or hemiarthroplasty were 18.7%(L), 0.77%(F), 24.2%(L) and 1.19%(F), respectively. Gastrointestinal problems(19.1%) were the most common cause for discontinuation of alendronate. CONCLUSION: It is important for doctors to approach osteoporosis more carefully and educate patients to follow the prescriptions in order to improve the low prescription and persistency rates for the management of osteoporotic hip fractures. Administration of alendronate may have a positive influence on the BMD of the proximal femur by lowering the rate of decreased BMD more than would be expected.

Clinical Outcome of Surgical Treatment of Distal Humerus Intercondylar Fractures Through the Transolecranon Approach Combined with Anterior Transposition of the Ulnar Nerve

PURPOSE: To analyze the clinical outcomes of surgical treatment of distal humerus intercondylar fractures through the transolecranon approach combined with anterior transposition of the ulnar nerve. MATERIALS AND METHODS: Eight patients who had distal humerus intercondylar fractures were included in this study and underwent operative treatment through the transolecranon approach for sufficient operative field with anterior transposition of the ulnar nerve and fixed with reconstruction plate. RESULTS: The results were evaluated using Riseborough and Radin rating criteria. Seven cases of eight cases were achieved good results with flexion contracture less than 30 degrees and forward flexion more than 115 degrees. However, one case was acheived poor result with 40 degrees of flexion contractue and 70 degrees of forward flexion. There were no the compressive ulnar neuropathy. CONCLUSION: We found the transolecranon approach and anterior transposition of the ulnar nerve a viable option for surgical treatment of the distal humerus intercondylar fractures

Hydroxyapatite Coated CLS Femoral Stem in Patients with Rheumatoid Arthritis: Minimum 5 Year Results / 대한정형외과학회잡지

PURPOSE: The study was undertaken in order to characterize the clinical and radiological results of total hip arthroplasty using a fully rough blasted stem with proximal hydroxyapatite coating in rheumatoid arthritis patients. MATERIALS AND METHODS: Twenty three total hip arthroplasties were performed using CLS stems in rheumatoid arthritis patients. Mean patient age of the patients and follow-up period were 53 and 6.8 years, respectively. Both clinical and radiographical parameters were evaluated. RESULTS: Chronological change of Harris hip score showed good results after 1 year. Harris hip score and the incidence of thigh pain at the last follow-up were 94 and one case, respectively. The mean time weight bearing without support was 12.5 weeks. Most endosteal bone formations around the stem appeared in the first 3 to 6 months. This was present in more than 80% of cases in zones 1, 2, 6, 7 and from 50 to 70% of cases even in zones 3, 4, 5 at the final follow-up. Loosening or implant failure was not found. Incomplete calcar fracture occurred in three cases, liner fracture around the femoral stem in one, heterotrophic ossification in one and superficial infection in one. CONCLUSION: The total hip arthroplasty using a CLS stem with a proximal HA coating may be a good choice in rheumatoid arthritis patients requiring hip arthroplasty.