Abductor Reconstruction with Gluteus Maximus Transfer in Primary Abductor Deficiency during Total Hip Arthroplasty / 대한고관절학회지

Abductor deficiency in native hip joint may cause severe limping and pain. It is more serious situation in case of arthroplasty due to instability and recurrent dislocation. Well-known causes of abductor deficiency are repeated surgery, chronic trochanteric bursitis, superior gluteal nerve injury, failure of repair of abductor tendon insertion to the greater trochanter. Author had experienced primary abductor deficiency during total hip replacement and treated successfully with the transfer of gluteus maximus. We'd like to introduce the operation technique with the review of literature.

Medial Plating of Distal Femoral Fracture with Locking Compression Plate-Proximal Lateral Tibia: Cases' Report

Generally, lateral plating is used for a comminuted fracture of the distal femur. However, in some cases, it has been shown that using a medial plate is necessary to achieve better outcome. Nevertheless, there are no available anatomical plates that fit either the distal medial femoral condyle or fracture fixation, except for the relatively short plate developed for distal femoral osteotomy. We found that locking compression plate-proximal lateral tibia (LCP-PLT) fits anatomically well for the contour of the ipsilateral medial femoral condyle. Moreover, LCP-PLT has less risk of breaking the thread holes since it rarely needs to be bent. We report a plastic bone model study and two cases of distal femoral fractures fixed with medial plating using LCP-PLT.

Unusual Cause of Hip Pain: Intrusion of the Acetabular Labrum / 대한고관절학회지

Femoroacetabular impingement and dysplatic hip joint is well known cause of osteoarthritis. In these diseases, labral tear and subsequent cartilage damage is thought to be main pathophysiology of development of osteoarthritis. If there are no known bony abnormalities, we called it as idiopathic osteoarthritis. Normal appearance of acetabular labrum is a continuous, usually triangular structure that attaches to the bony rim of the acetabulum and is completed at the inferior portion by the transverse acetabular ligament over the acetabular notch. A few authors reported intra-articular labrum and its relation to the development of osteoarthritis. But they didn't comment the primary bony abnormality especially acetabulum. We'd like to report x-ray, computed tomogram, magnetic resonance arthrogram and arthroscopic findings of a case had double contour sign of acetabular dome combined with intrusion of acetabular labrum.

Arthroscopic Treatment of Cam Type Femoroacetabular Impingement: Short Term Results / 대한고관절학회지

PURPOSE: We evaluated the short term results after treatment of cam type femoroacetabular impingement (FAI) by arthroscopy. MATERIALS AND METHODS: We evaluated the clinical and radiological results of arthroscopically treated cam type FAI in patients who had failed conservative treatment with hip pain, with at least 12 months follow-up, from November 2010 to December 2012. There were 19 males and six females. Mean age of patients was 32.9 years (19-57 years) and mean follow up period was 17.2 months (13-31 months). We analyzed the alpha angle, head neck offset, visual analogue scale (VAS), and modified Harris hip score (MHHS). RESULTS: Mean alpha angle improved from 64.8degrees to 39.9degrees and mean head neck offset also improved from 0.8 to 7.6 mm. Peripheral longitudinal and radial fibrillated labral tear was the most common in the anterosuperior quadrant. Damage to acetabular cartilage was identified in 14 patients. Mean VAS improved from 6.3 to 0.9 and mean MHHS improved from 51.7 to 73.6. Complications associated with the operation included three cases of femoral head articular cartilage injury, two cases of pudendal nerve injury, and two cases of lateral femoral cutaneous nerve injury. CONCLUSION: Although the short term results for arthroscopically treated cam type FAI were satisfactory, care must be taken to reduce the complications associated with arthroscopy and long term follow is needed in order to determine whether or not it can reduce osteoarthritis of the hip.

Morbidity and Mortality of the Elderly after Early Operation for Trochanteric Fractures

PURPOSE: To find out the effect of early closed reduction and internal fixation (within 24 hours after admission to hospital) on the morbidity and mortality in the elderly with intertrochanteric fractures of the femur. MATERIALS AND METHODS: Retrospectively, we analyzed 99 patients with intertrochanteric fracture of the femur who underwent surgery from January, 2009 to December, 2010. We reviewed 89 of the 99 patients and checked for early complications and reviewed the mortality rates 3 months, 6 months and 1 year after surgery. There were 24 males and 65 females. The average age was 79.8 years (61-99 years). According to the American Society of Anesthesiologists classification, 25 patients were class 1, 37 patients were class 2, 26 patients were class 3, and 1 patient was class 4. All patients were operated on by one surgeon, who was skilled in inserting intramedullary nail. RESULTS: The average surgical time was 43 minutes and the average intraoperative blood loss was 165 ml. Sixteen patients experienced delirium but all of them recovered. One patient had pneumonia at one month after surgery. Pressure sores developed in one patient but improved with conservative treatment. Pulmonary thromboembolism developed in some patients one month after surgery. Three patients (3.4%) died within three months and one patient (1.1%) died between three and six months after surgery, but no patient died between six months and one year after surgery. CONCLUSION: If patients are optimized for the operation, early internal fixation of trochanteric fracture in elderly patients after arrival at the hospital should be considered to reduce early complications and mortality.

Bleeding Volume after Surgery for Trochanteric Fractures of the Femur in Patients Treated with Antiplatelet Agents: Comparison according to Surgical Timing

PURPOSE: We evaluated the bleeding volume after surgery for trochanteric fractures of the femur in patients treated with antiplatelet agents according to surgical timing. MATERIALS AND METHODS: We selected 20 patients who had trochanteric fractures of the femur treated with antiplatelet agents from January 2009 to June 2010. Group I included 9 patients who discontinued antiplatelet medication and had delayed operations at an average of 6.5 days and Group II included 11 patients who underwent early operations within 24 hours. Group I included 2 males and 7 females; their average age was 77.8 years (range 59~86). Group II included 4 males and 7 females, with an average age of 73.5 years (range 61~84). We compared the two groups' volume of intraoperative bleeding, the preoperative and postoperative hemoglobin levels and the volume of postoperative transfusion. The Mann-Whitney U test was used for statistical analysis. RESULTS: The volume of intraoperative bleeding was 88 ml in group I and 106 ml in group II (p>0.01). The difference in the hemoglobin was a decrease of 2.4 mg% in group I and a decrease of 2.2 mg% in group II (p>0.01). The volume of postoperative transfusion was 0.6 pints in group I and 1 pint in group II (p>0.01). CONCLUSION: We found a similar bleeding volume regardless of operative timing after surgery for trochanteric fractures of the femur in patients treated with antiplatelet agents.

A Case Report of Unique Complications of PFNA Penetration of the Blade into the Hip Joint

The proximal femoral nail anti-rotation (PFNA) is a useful device to fix trochanteric fractures of the proximal femur. We report a case of postoperative penetration of the helical blade through the femoral head into the hip joint without any sign of rotational or varus instability in the fracture.