Results of Asian Type Gamma 3 Nail in Treatment of Trochanteric Fractures

PURPOSE: This study was conducted in order to demonstrate the radiologic and clinical results of using the Asian type gamma 3 nail in treatment of trochanteric fractures. MATERIALS AND METHODS: Patients underwent operations with gamma 3 nails between August 2010 and August 2012. For the radiologic evaluation, we analyzed bone quality, fracture pattern, reduction quality, union period, and position of lag screw (tip-apex distance, Cleveland index). For the clinical evaluation, we analyzed mobility score of Palmer and Parker and Jensen's functional score. RESULTS: The mean union was taken at 17.4 weeks (14-25 weeks). Two cases (4.3%) underwent reoperation due to cutting out of the hip screws. The clinical outcomes of Parker and Palmer's average mobility score changed from 7.3 to 5.8 (79%), Jensen's functional score was 1.3 to 1.8 (72%). CONCLUSION: We achieved excellent clinical and radiological outcomes; therefore, Asian type gamma 3 nail is effective in treatment of trochanteric fractures of the femur in Korea.

Targon(R) Proximal Femoral Nail Used for Treatment of Intertrochanteric Femoral Fractures

PURPOSE: We evaluated the clinical and radiological outcomes related to use of the Targon(R) proximal femoral nail for repairing femoral intertrochanteric fractures. MATERIALS AND METHODS: Between April 2004 and November 2005, the records of 56 patients with intertrochanteric fractures treated with the proximal femoral nail, were analyzed. The mean patient age was 75.2 years. The mean duration of follow-up was 32 months. There were 26 stable fractures and 30 unstable fractures. Clinical assessment included parameters of operating time, transfusion rate, pain analysis by visual analogue scale (VAS), timing of maximum tolerable weight-bearing, functional evaluation by modified Koval index, and complications. Radiological assessment was directed toward adequacy of reduction, union time, and changes observed between immediate postoperative and final follow-up roentgenograms in various parameters. RESULTS: The mean operating time was 37 minutes. Visual analogue scale at final follow-up was 2.8 on average, and 38 of 43 preoperative ambulators (88%) were able to bear weight as much as tolerable within 6 weeks postoperatively. Postoperative mobility recovered to pre-injury levels in 40 cases (71%). Radiologic evaluation showed adequate reduction in all cases. Mean union time was 8.9+/-2.5 weeks. The neck-shaft angle changed at final follow-up an average of 3.6+/-1.9(R). The femoral shaft displaced medially an average of 2.8+/-0.9 mm, and the lag screw slid an average of 4.7+/-0.6 mm. Complications such as cutting through, Z-effect, and femoral shaft fracture were not observed in any cases. CONCLUSION: The Targon(R) proximal femoral nail showed excellent results in terms of early ambulation, clinical recovery, and radiologic parameters and may be a useful implant for treating femoral intertrochanteric fractures.

Nonunion of the Humerus Shaft

PURPOSE: To evaluate the cause and treatment results of nonunion of humerus shaft fractures. MATERIALS AND METHODS: 39 cases were treated for humerus shaft nonunion between February 1990 and May 2002. The presence of open wounds, initial treatment modality after injury, treatment method for the nonunion and time to union were studied using medical records. The fracture type and appropriateness and problems of the initial surgical treatment were reviewed. Also, Pain and functional recovery in daily living were evaluated in the outpatient clinic, after surgery for nonunion. RESULTS: Amongst the 30 cases, transverse fracture was the most common with 19cases. Most of 29 cases, initially surgically treated, revealed incorrect selection of the internal fixator or technical errors. For surgical treatment of nonunion, open reduction and internal fixation with cancellous bone graft was performed, most commonly, in 36 cases (92.3%). All cases showed clinical and radiographic union at an average of 13.3 weeks. More than 90% of the patients replied minimal pain and excellent functional recovery of daily living at final follow-up. CONCLUSION: If treated with surgery by correct selection of internal fixation methods and accurate technical skills, nonunion incidence can be reduced.

Prognostic Factors of Hemiarthroplasty for the Proximal Humeral Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of the study was to evaluate the results and analyze various prognostic factors of hemiarthroplasty for proximal humeral fractures. MATERIALS AND METHODS: Thirty-one cases, who underwent hemiarthroplasties for proximal humeral fractures, were evaluated with ASES score at a mean follow-up of 45 months (1-8 years). Global Total Shoulder (Depuy.) (TS Gr) for 21 cases, and Global FX (Depuy.) (FX Gr) for 10 cases were used. Twentysix cases were acute fractures within one month after injury. There were two cases with delayed union and three cases with nonunion. Prognostic values of age, delay of surgery, fracture type, position of the greater tuberosity and design of implant were assessed. RESULTS: The most important prognostic factor was the design of implant. Mean score of FX Gr was significantly higher than that of TS Gr (84.4 and 77.6 respectively, p=0.036). Age, fracture type, delay of surgery and position of the greater tuberosity did not show any prognostic value. CONCLUSION: The clinical results of Hemiarthroplasty specially designed for the proximal humeral fractures has better than that of preexisting implant. Design of the implant was considered to be the most important prognostic factor of hemiarthroplasty for the proximal humeral fractures.

Retrograde Pin Fixation with Tension Band Wiring for the Proximal Humeral Fractures / 대한정형외과학회잡지

PURPOSE: To introduce a surgical technique of retrograde pin fixation with tension band wiring for the proximal humeral fractures and to evaluate the clinical results. MATERIALS AND METHODS: The clinical results of thirty-two patients who underwent surgical treatment for the proximal humeral fractures, during the period from June 1996 to June 2001, using a retrograde pin fixation with tension band wiring were reviewed. The mean followup was 2.5 years (1-5 years) Twelve patients had a two-part fracture, and twenty patients had a three-part fracture with Neer's classification. We analyzed the clinical results using Neer score and radiological state using Zyto's three-point graded scale. RESULTS: By clinical evaluation, eighteen cases (56%) were excellent, twelve cases (38%) were satisfactory, one case (3%) was unsatisfactory and one case (3%) was failure. By radiological evaluation, twenty-one cases (66%) were good, nine cases (28%) were acceptable and two cases (6%) were poor. Three unsatisfactory cases were a case with pin migration, loss of reduction or avascular necrosis. There was not a case of delayed union, nonunion or infection. CONCLUSION: Retrograde pin fixation with tension band wiring for the proximal humeral fractures was considered to be a useful method, which is easy and induces limited soft tissue injury, and provides enough stability for postoperative rehabilitation in majority cases such as surgical neck or three-part fractures.

Modified Tenson Band Fixation for Unstable Fracture of the Distal Clavicle / 대한정형외과학회잡지

PURPOSE: The aims of this study were to introduce a new surgical technique for unstable fracture of the distal clavicle, and to evaluate the clinical results. MATERIALS AND METHODS: The clinical results of nineteen patients who underwent surgical treatment for unstable fracture of the distal clavicle, during the period from March 1995 to December 1999, using a modified tension band fixation with follow up over one year were reviewed. Outcome was analyzed in terms of pain, function, radiologic result and union time. RESULTS: All cases showed satisfactory results; eighteen cases (95%) were excellent, and one case (5%) was good. Radiologic union was achieved on average at eight weeks (six-tweleve) after operation. No complications such as pin migration, metal breakage and nonunion were seen. CONCLUSION: Modified tension band fixation for unstable fracture of the distal clavicle was found to be a useful method, which is easy and induces no injury of the acromioclavicular joint, and provides enough stability for postoperative rehabilitation.

Anatomical Repair of Massive Rotator Cuff Tear / 대한정형외과학회잡지

PURPOSE: We evaluate the possibility of the anatomical repair of massive rotator cuff tear and review the clinical results. MATERIALS AND METHODS: From March 1995 to June 1999, twenty-six cases of massive rotaor cuff tear were reviewed with minimal followup of one year. The clinical results were evaluated using ASES (American Shoulder and Elbow Surgeons) score. RESULTS: Twenty two cases (85%) showed satisfactory results, 8 excellent results (31%) and 14 good results (54%). There were four cases (15%) of unsatisfactory results, two cases of fair and two cases of poor results. Mean value of the ASES score increased from 41 (14-60) points to 83 (46-98) points. Mean value of the increased score was 42 (20-76) points. There were no cases of functional deterioration or revision surgery. CONCLUSION: Anatomical repair was considered to be practically possible in the majority of cases of massive rotator cuff tear as an initial treatment.

Analysis of West Point View in Anterior Shoulder Instability / 대한정형외과학회잡지

PURPOSE: To evaluate the usefulness of the West point view, we investigated the osseous pathology of the glenoid rim associated with shoulder instability and estimate the inter-observer reliability. MATERIALS AND METHODS: The West point views of sixty-seven patients with labral lesion confirmed by operation were mixed with those of thirty-three normal controls. Six observers independently reviewed the mixed radiographs and checked the lesion by identifying the glenoid erosion, bony defect, ectopic ossification and Hill-Sachs lesion. The incidence of osseous lesions suggesting instability was estimated. Sensitivity in the patient group, specificity in the normal control and inter-observer reliability were calculated to evaluate study susceptibility. RESULTS: The sensitivity of 67 patients group was 81.8% on average (73-94%), the specificity of 33 member control group was 85.2% (82-94%). The most frequent finding was glenoid erosion, with an average of 54.7%, which providing a sensitive clue of shoulder instability. Inter-observer reliability analyzed by using Kappa values showed significant agreement. (alpha=0.1 significant level). CONCLUSION: The West point view is considered to be a reliable diagnostic modality for shoulder instability. The additional sophisticated method is indicated only when a discrepancy between physical examination and radiologic findings exists.

Surgical Treatment of the Acute Acromioclavicular Joint Dislocation Using a Wolter Plate / 대한정형외과학회잡지

PURPOSE: To introduce the surgical technique of acute acromioclavicular joint dislocation using a Wolter plate and to evaluate its efficacy after surgical treatment. MATERIALS AND METHODS: Twenty-six patients who underwent surgical treatment of the acute acromioclavicular joint dislocation using a Wolter plate and who were followed up minimally for one year were reviewed. We analyzed the clinical results of pain, function, range of motion and radiologic reduction state of the acromioclavicular joint. RESULTS: All cases showed satisfactory results. By clinical evaluation, twelve cases (46%) were excellent and fourteen cases (54%) were good. By radiologic evaluation, twenty cases (77%) were excellent and six cases (23%) were good. By postoperative X-ray, vertical displacement of the clavicle was restored in all cases. No complications such as infection, loosening of screws, plate failure or redislocation after removal of the plate occurred. CONCLUSION: Acromioclavicular joint reconstruction using a Wolter plate is believed to be a useful method, which minimizes injury of the joint articular surface and provides enough stability for postoperative rehabilitation.

Cemented Fixation Method of Glenoid Prosthesis in Total Shoulder Arthroplasty in a Pig Model / 대한정형외과학회잡지

PURPOSE: To observe the amount and distribution of overflown cement on the backsurface of the glenoid prosthesis and to determine the amount of cement required for ideal fixation of the glenoid prosthesis. MATERIALS AND METHODS: 48 keeled type glenoid prostheses (Global total shoulder, Depuy Co., U.S.A.) were fixed with four different volumes of cement (fully filled in the slots, and cement removed to depths of 4, 7 and 10 mm) to the scapulae of mature pigs, in which 46 scapulae that could be freed from the prostheses were investigated in terms of the amount and distribution of the leaked cement by gross inspection and evaluation using Arc view GIS 8.1. RESULTS: The cement overflowed in an irregular fashion. The average ratio of the area covered by leaked cement to glenoid surface was 30.7% (12.9-52.2) in 27 cases, in which the slots were completely filled by cement; 19% (13.4-29.9) in 6 cases in which a 4 mm depth of cement was removed from the slots; 1.8% (-7.5~16.8) in 8 cases in which a 7 mm depth of cement was removed from the slots; -10.2% (-15.8~-5.2) in 5 cases in which a 10 mm depth of cement was removed from the slots. CONCLUSION: It is impossible to prevent leakage of cement behind the backsurface of the glenoid prosthesis with the conventional cemented fixation method. This can be prevented by removing the equivalent amount of cement before inserting the prosthesis.

Capsular Imbrication and Bankart Repair in Traumatic Anterior Shoulder Instability : Effect of Subscapularis Tendon Division on Internal Rotator Strength and Shoulder Function / 대한정형외과학회잡지

PURPOSE: To evaluate the function of the shoulder and the effect of the division of the subscapularis tendon on the strength of the inter-nal rotator after capsular imbrication and Bankart repair. MATERIALS AND METHODS: From January, 1996 to December, 2000, we reviewed thirty cases of traumatic anterior shoulder instability, which underwent capsular imbrication and Bankart repair. The follow up period was minimally one year. The clinical results were evaluated using the ASES (American Shoulder and Elbow Surgeons) score and the muscle power of the internal rotator as measured by a myometer. RESULTS: All cases showed satisfactory results; nineteen cases (63%) were excellent, and eleven cases (37%) were good. Mean value of ASES score increased from 78.6 (60-82) ponts to 94.5 (84-100) points. Mean value of the score increased was 16 (14-38) points. Postoperatively, the muscle power of the internal rotator compared with contralateral was increased in 12 cases (40%), decreased in 17 cases (57%), and was the same in one case (3%). There was no cases of deterioration of function, recurrence or requiring revision surgery. CONCLUSION: In capsular imbrication and Bankart repair, the division of the subscapularis tendon did not produce a significant adverse effect in the strength of the internal rotator. We believe that this is one of the useful treatment methods in traumatic anterior shoulder insta-bility, because it provides stability and a good range of motion.