Comparison of Angle Measurements on Hallux Valgus with Two Different Methods Using Digital Images / 대한족부족관절학회지

PURPOSE: To study inter- and intra-observer reliabilities of computerized measurements of the angular parameters of hallux valgus deformity, using two different kinds of software tools for angle measurement on the digital radiography. MATERIALS AND METHODS: On 35 digital radiographies of standing foot anteroposterior view of hallux valgus, two observers (A, B) independently measured hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA1-2) twice, using two methods. In method I, an angle was determined from duplicated lines to longitudinal axes made for bisecting line on the target bones with software tool. In method II, an angle was calculated automatically and directly from bisecting lines (longitudinal axes) made on the target bones. We compared two methods using paired t-test to determine significance of differences. Inter- and intra-observer reliabilities were evaluated using the intraclass correlation coefficients (ICC). RESULTS: There were no significant differences between measurements of method I and II for each observer (p>0.05) and intraobserver reliability were good. (ICC>0.9) Inter-observer reliability for method I and II was good of the HVA (ICCs, 0.912 and 0.905) and moderate of the IMA1-2 (ICCs, 0.505 and 0.537). There were interobserver differences in HVA of method I and II. CONCLUSION: No significant difference was found statistically between measurements of method I and II. Both methods I and II would be acceptable to measure angular parameters of hallux valgus deformity.

Computerized Measurement on Angular Parameters for Hallux Valgus: Comparison of 100% and 150% Magnified Digital Radiography / 대한족부족관절학회지

PURPOSE: To study computerized measurements of angular parameters on 100% and 150% resized digital radiography of hallux valgus deformity. MATERIALS AND METHODS: 30 digital radiography of standing foot anteroposterior view of hallux valgus patients were included. Two observers(A, B) independently measured hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) in two times on both 100%-size and 150% magnified images respectively, using computerized measurement software tools. The results were interpreted with the statistical software program, Statistical Analysis System, version 9.2. RESULTS: In repeated measurements of each observer, measurements on 150% magnified image showed no differences of all three parameters and with 100%-size image, there were differences of HVA (observer A) and 1-2 IMA (observer B) (p>0.05). When testing interobserver reliability, both observers showed differences in measurement of HVA and DMAA (p<0.05), but no differences in measurement of 1-2 IMA in both images. Within the 95% confidence interval, limits of error of measurements between two observers on HVA, IMA and DMAA were 2.7degrees 1.4degrees and 5.0degrees respectively in 100%-size images, and 2.6degrees, 1.6degrees and 4.7degrees respectively in 150% magnified images. CONCLUSION: In computerized measurements for angular parameters of hallux valgus with digital radiography, 150% magnified images showed intraobserver reliability. Both 100% and 150% magnified images failed to show interobserver reliability. Measurement of 1-2 IMA in both 100% and 150% images showed less interobserver error.

The First Metatarsophalangeal Arthrodesis with Screws Fixation / 대한족부족관절학회지

PURPOSE: The aim of this study was to retrospectively evaluate the clinical and radiological results of the first metatarsophalangeal joint arthrodesis with two crossed screws fixation. MATERIALS AND METHODS: We treated 23 patients (24 cases) with arthrodesis of the first metatarsophalangeal joint using two crossed screws fixation between December 2000 and May 2005. There were 3 male patients and 20 female patients. Ages ranged from 28 to 74 years (mean, 50 years). Follow-up ranged from 4.1 to 8.2 years (mean, 6.5 years). The American Orthopaedic Foot and Ankle Society (AOFAS) score and their satisfaction was evaluated clinically, foot anteroposterior and lateral radiograph, radiologically. RESULTS: Of the 24 cases, 6 had surgery for dorsal plate and screws fixation because of failure to acquire firm fixation with two crossed screws fixation. All 6 cases acquired bony union. Fusion of the hallux first metatarsophalangeal joint occurred in 16/18 cases (89%). Nonunion occurred in 2 cases (11%) and was asymptomatic. At last follow-up, hallux valgus angle ranged from 11 to 25 degrees(mean, 17.7 degrees), dorsiflexion ranged from 15 to 25 degrees (mean, 22 degrees).The mean preoperative AOFAS score of 37 points(range, 28 to 45 points) improved to a mean of 77 points (range, 65~90 points) postoperatively. The result of the procedure as rated subjectively by the patient was excellent for 5 cases, good for 11 cases and fair for 2. CONCLUSION: Comparatively, the arthrodesis of the first metatarsophalangeal joint with crossed screws fixation showed a satisfactory clinical results, we thought that require technical attention for firm fixation in operation.

Does a Radiolucent Zone Surrounding the Pedicle Screws mean Nonunion? / 대한정형외과학회잡지

PURPOSE: We wanted to retrospectively evaluate the clinical significance of radiolucent zones surrounding the pedicle screws after spinal fusion. MATERIALS AND METHODS: Spinal surgery was performed between May 2003 and December 2005 on elective patients with degenerative lumbar disorders and they underwent transpedicular screw fixation and posterolateral fusion and these patients were the subjects of the study. There were 124 cases with more than 2 years of follow up. Determination of the radiolucent zones around pedicle screws was done using simple x-rays and the cases were divided in to 4 different groups: segmental fixation with short (2 or less segments) or, long (3 or more segments) segmental fixation and those cases with or without sacral fixation. Comparative analysis was done according to osteoporosis, the location of the pedicle screws, the degree of bony-union and fixation of the anterior cortex of the sacrum. RESULTS: Among the 124 cases and 846 pedicle screws, 189 pedicle screws (22%) had radiolucent zones; 151 of the 189 pedicle screws with a radiolucent zone (27%) were in the sacral fixed group, while 38 of the 189 pedicle screws with a radiolucent zone (13%) were in the non-sacral fixed group, and the difference was significant (p=0.001). In the case of anterior cortical fixation in the sacral fixed group and the complete bony-union, the radiolucent zones had a significantly lower incidence, while the group of patients with osteoporosis (a T score lower than -2.5) had a higher incidence of radiolucent zones. CONCLUSION: The radiolucent zones surrounding the pedicle screws after spinal fusion were closely related to spinal fusion with sacral fixation and pseudarthrosis, and these radiolucent zones mostly occurred before complete bony-union. The existence of osteoporosis and the techniques of sacral fixation and many different contributing factors must be considered, and careful monitoring is needed even if the radiolucent zone progressive after complete bony-union.

Uncemented Bipolar Hemiarthroplasty for Femoral Neck Fracture in Patients Older Than 75 Years of Age

Purpose: This study examined the clinical and radiographic outcomes of uncemented bipolar hemiarthroplasty for femoral neck fractures in elderly patients with osteoporosis Materials and Methods: Between March 2002 and July 2004, 48 uncemented bipolar hemiarthroplasty procedures (Zweymuller, Plus Orthopedics AG, Rotkreuz, Switzerland) for femoral neck fractures were performed in 47 patients older than 75 years of age. Of the 48 patients, 1 patient died during the follow-up period. There were 11 men and 36 women. The mean age of the patients at the time of surgery was 81 years (range, 75 ~ 94 years), and the mean follow up period was 42 months(range, 24 ~ 58 months). The bone mineral density and canal flare index of the proximal femur were measured in all patients. Results: The mean bone mineral density (T score) was -3.9 points (range, -2.9 ~ -5.3) and the proximal femoral morphology showed stove pipe shapes in 33 hips. At the last follow up, the mean Harris hip scores and visual analogue scale score was 85 (range, 75~93) and 2.7 (range, 1 ~ 6)points, respectively. Inguinal pain was observed in thirteen hips, among which the degree of pain was moderate in 1 and mild in 12. Radiologically, none of the stems showed evidence of osteolysis and aseptic loosening, and remained well osseointegrated without subsidence. Conclusion: Uncemented bipolar hemiarthroplasty using a Zweymuller stem in elderly patients associated with osteoporosis can provide favorable clinical and radiographic results because the stem imparts good primary stability due to its rectangular tapered shape and long-term secondary stability due to excellent osseointegration on the gritblasted surface.

Traumatic Pseudoaneurysm of Posterior Tibial Artery in a Child: A Case Report

Pseudoaneurysm is one of the complications of arterial injuries by trauma. The case report in children is rare, although not in adult. A 7-year and 10-month girl was visited with the complaints of pain and a mass in her right leg. At first, the radiograph of right tibia showed a remarkable cortical erosion from without, suggesting mass effect by a soft tissue tumor. She had a history of fracture of right tibia, and then manipulative reduction and K-wire fixation at 11 months ago. Arteriography showed a formation of the pseudoaneurysm originated from the posterior tibial artery. The operation was done through the ligation of artery at proximal and distal to pseudoaneurysm, and then excision of mass. At 5 year follow-up, the configuration and function of right foot was normal. Eventually, the cause of the mass formation is thought by the trauma of fracture fragment at the time of accidents, but the possibility of penetrated injuries by K-wire should be ruled out, which is used frequently in children's fracture. We experienced a case of traumatic pseudoaneurysm of posterior tibal artery with tibial fracture, especially occurred in pediatric patient, and presented the result of long-term follow-up.