Comparison of Flexible Intramedullary Nailing with External Fixation in Pediatric Femoral Shaft Fractures / 대한정형외과학회잡지

PURPOSE: This study compared the results of external fixation with those of flexible intramedullary nailing using Ender nails in pediatric femoral shaft fractures. MATERIALS AND METHODS: Twenty-eight children with pediatric femoral shaft fractures were enrolled in the study. The children's ages ranged from 6 to 11 years, and the average period of follow-up was 27.2 months. Fifteen patients underwent flexible intramedullary nailing (FIN) using Ender nails and thirteen patients underwent external fixation (EF). The outcomes were assessed based on the clinical and radiology findings. RESULTS: The healing time averaged 9.8 weeks in the FIN group and 11.2 weeks in the EF group. In the FIN group, one patient suffered pin migration. In the EF group, three patients had a pin site infection, one patient had refracture after removing the external fixator and one patient had pin breakage 8 weeks after surgery. The broken pin was removed and the condition was stabilized with internal fixation using a plate. CONCLUSION: Flexible intramedullary nailing with Ender nails is an effective treatment option for treating femoral shaft fractures in children because it has fewer complications than external fixation does.

Neglected Type IV Acromioclavicular Joint Injury: 2 Cases Report

Acromioclavicular joint injuries usually occur as a result of direct trauma to the superolateral aspect of the shoulder. Roockwood Type IV injuries are relatively uncommon, and they are easily misdiagnosed or neglected in patients who have suffered multiple traumas. Therefore, to correctly treat a patient with type IV injury, we need to take a careful physical examination and conduct proper radiologic evaluation for the acromioclavicular joint. We report here on two cases of modified Weaver-Dunn reconstruction for neglected type IV acromioclavicular joint injuries that were associated with multiple rib fractures.

Short-term Outcomes of Arthroscopic Transtendinous Repair in Partial Articular Side Tears of the Rotator Cuff

PURPOSE: This study prospectively evaluated the outcome of arthroscopic transtendinous repair as a treatment for partial articular side tears of the rotator cuff. MATERIALS AND METHODS: Fifteen patients with symptomatic, partial articular side tears of the rotator cuff underwent modified transtendinous repair. The patient's mean age was 52.5 years and the mean duration of symptoms was 33.7 weeks. The visual analogue scale (VAS), the ASES score, the active ROM of the shoulder and the patient's satisfaction were evaluated both preoperatively and postoperatively. The clinical results were analyzed using the Wilcoxon's signed rank test. RESULTS: The mean VAS was 6.6+/-1.1 before treatment and 0.4+/-0.6 at 6 month, and the ASES scores for all the patients were significantly better over the six-month period of follow-up (p<0.05). The mean active ROM in abduction was 94.3+/-22.3 before treatment, 108.7+/-16.3 at 1 month (p=0.0041) and 164.3+/-5.3 at six months (p=0.0006). In flexion, it was 105.0+/-23.8 before treatment, 119.0+/-17.4 at 1 month (p=0.0075) and 174.3+/-5.3 at six months (p=0.0006). At the final follow-up, 94% of patients were satisfied or very satisfied after operation. CONCLUSION: We experienced satisfactory clinical results after a short-term follow-up of arthroscopic transtendinous repair, and we believed this to be an effective procedure for patients with partial articular side tears of the rotator cuff.

Posterior Shoulder Dislocation with a Greater Tuberosity Fracture and Total Rupture of Rotator Cuff: A Case Report

A posterior shoulder dislocation with a fracture is rare. Most fractures are impression fractures of the humeral head or lesser tuberosity fractures. However, there are no reports of a complete rupture of the rotator cuff with a combined posterior glenohumeral dislocation. We report a unique case of a posterior shoulder dislocation with an avulsion fracture of the greater tuberosity and a complete rupture of infraspinatus, teres minor and subscapularis tendons, which were treated surgically.

Treatment of Rotator Cuff Tear Arthropathy with Prosthetic Replacement of Humeral Head / 대한정형외과학회잡지

PURPOSE: To assess the effectiveness of a prosthetic replacement of the humeral head in rotator cuff tear arthropathy patients. MATERIALS AND METHODS: 11 patients underwent a prosthetic replacement of the humeral head for rotator cuff tear arthropathy between 1997 and 2003. The average age was 69 years and 9 out of the 11 patients were women. The average follow-up was 44 months. The level of pain, daily activities, range of motion and patient's satisfaction were assessed both preoperatively and postoperatively. RESULTS: The mean pain score decreased from 9.0 preoperatively to 2.2 postoperatively. The mean active forward elevation increased from 40o to 82o and the mean external rotation increased from 8.2o to 30o. The mean ASES score improved from 22 to 72. Nine patients were satisfied with the surgical outcome, particularly in terms of pain relief and the improvement in their daily activities. CONCLUSION: A prosthetic replacement of the humeral head is an effective treatment option for pain relief as well as for improving the functional activity in rotator cuff tear arthropathy.

Influences of Particles on Pro-inflammatory Signalings in Pre-osteoclasts / 대한정형외과연구학회지

PURPOSE: To evaluate the roles of macrophages and their influences on the signal transduction in the periprosthetic osteolysis, the pro-inflammatory signals were analyzed in particles-stimulated macrophages. MATERIALS AND METHODS: Raw 264.7 cell line derived from mice macrophages was used as pre-osteoclasts. To increase the stimulatory effects, the particles were composed of PMMA and polyethylene. Under the similar conditions as osteoclast differentiation, we examined the effect of particles on the pro-inflammatory signals in macrophage: the production of TNF-alpha, the activity of MAPKs (mitogen-activated phosphorylation kinase), the expression of I-kappaB (Inhibitory (B) and the production of H2O2 and nitric oxide. RESULTS: The particles stimulated the secretion of TNF-alpha and increased the phosphorylation of p38 and ERK in course of time. The concentration of H2O2 was increased; however the nitric oxide formation was not increased by particle treatment. In addition, the production of H2O2 was synergistically increased by suboptimal stimulation with PMA (phorbol 12-myristate 13-acetate). Expressions of I-kappaB were inhibited by particles. CONCLUSION: The particles may stimulate the activation of MAPKs, the production of TNF-alpha, reactive oxygen species (ROS) and the activation of NF-kappaB in the pre-osteoclasts. We speculate that particles may mediate the pro-inflammatory signal cascade by the activation of NF-kappaB through ROS in pre-osteoclasts, rather than reactive nitrogen species (RNS). Therefore we suggest that the macrophages in inflammatory osteolysis may have the characteristics of pre-osteoclast as well as pro-inflammatory cell. Further researches should be recommended.

Effect of aging on the production and the action of nitric oxide in articular cartilage / 대한정형외과학회잡지

PURPOSE: We investigate the age-related changes in the production of nitiric oxide (NO) in the articular cartilage and its effects on cell proliferation. MATERIALS AND METHODS: Forty New Zealand white rabbits of four different age groups were used. There were 10 rabbits in each group and the age groups were 1 month, 6 months, 1 year and 3 years of age. We measured the basal and induced production of NO in cultured articular chondrocytes that were obtained from distal femur by using a nitrite assay. We observed the changes in the proliferative activity of the chondrocytes after exogenous NO administration using a nonradioisotopic proliferation assay. In addition, we also detected endothelial nitric oxide synthase (eNOS) in articular cartilage using immunohistochemical staining. RESULTS: The basal and induced levels of NO were lower in the cultured chondrocytes from older rabbits. Exogenous NO administration suppressed the proliferative activity of chondrocytes to a greater degree in the younger rabbits than in the older ones. Immunohistochemistry showed a predominance of eNOS positive chondrocytes in the superficial layer. The number of eNOS positive chondrocytes decreased in older rabbits. CONCLUSION: The production of NO decreased with aging in normal articular cartilage. The suppression of proliferative activity in chondrocytes by exogenous NO declined with aging.