Multiple Brachymetacarpia Treated by Distraction Osteogenesis

The treatment of a brachymetacarpia using a distraction osteogenesis was mostly single, unilateral pattern. In case of multiple brachymetacarpia, single-stage lengthening or rapid distraction lengthening with a bone graft were usually used. Multiple brachymetacarpia treated by distraction osteogenesis is rarely reported. We report a case of a 15-year-old female presented with bilateral multiple brachymetacarpia treated by distraction osteogenesis simultaneously without complications. Also, we have evaluated the clinical results and factors which influence the clinical results.

Result of Total Knee Arthroplasty in Pre-operative Adreanal Insufficiency Patients / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to investigate to effect of adrenal insufficiency on the results of TKA. MATERIALS AND METHODS: A total of 89 patients (89 knees) treated with TKA from March, 2008 to October, 2008 were enrolled in this study. Levels of serum cortisol and adrenocorticotropic hormone (ACTH) were checked preoperatively. Hydrocortisone 50~75 mg was injected to adrenal insufficient group at 7:00 AM and 4:00 PM on operative day and the following day. We evaluated the range of motion, the knee society knee score and function score at preoperatively and 2 years follow up, and compared the results between non-adrenal insufficiency group (NAI) and adrenal insufficiency group (AI). RESULTS: Cortisol and ACTH levels were reduced in 36 of 89 patients. All of 36 patients of low cortisol level do not stimulated in ACTH stimulation test. In the adrenal insufficiency group the knee society score (KSS) improved from 49.8 to 86.8 and the knee society functional score (KSFS) from 42.6 to 89.5 at 2 years follow-up. In the control group KSS rose from 51.9 to 84.3 and KSFS from 49.4 to 88.6 during the same period. In adrenal insufficient patients, there were no postoperative complication to include mortality, infection, periprosthetic fracture except skin lesions during operation or postoperatively. There was a case of rupture of quadriceps tendon on the 10th postoperative day which was treated with primary repair. CONCLUSION: Based on our study, there was no increased operative and postoperative complications except skin lesions and 1 case quadricepse tendon rupture in patients with adrenal insufficiency group.

Postoperative Complications of Hip Fractures in Patients with Chronic Kidney Disease

PURPOSE: The purpose of the present study was to evaluate the factors affecting the complications and the mortality rate after surgery for hip fractures in patients with chronic kidney disease. MATERIALS AND METHODS: We retrospectively analyzed 59 patients with chronic kidney disease and who were managed with surgical treatment after hip fracture between February 2001 and February 2007. The average age was 72 (range: 45~83) years old. There were 21 men and 38 women. The postoperative complications and mortality rate were analyzed according to the patients' age and gender, the comorbid medical diseases, the preoperative pulmonary function tests, the timing of the operation and the operation methods, the American Association of Anesthetists score and the estimated glomerular filtration ratio (eGFR). RESULTS: For 59 patients with chronic kidney disease, the overall complication rate was 35.9% and the mortality rate was 15.3%. The patients with poor pulmonary function showed a high mortality rate in the postoperative period. The timing of the operation and the ASA score were associated with the postoperative complications rate and the mortality rate. CONCLUSION: Respiratory complications were dominant in the hip fracture patients with chronic kidney disease. The cause of death was mainly associated with pneumonia and a septic condition. Careful management must be done during the postoperative period to prevent infectious complications.

The Expression of Extracellular Matrix mRNA in the Chondrocytes of the Femoral Head Affected by Avascular Necrosis

PURPOSE: The aim of this study was to evaluate the expression of type II collagen, aggrecan, VEGF-A and PEDF mRNAs in the human chondrocytes derived from the articular cartilage of the femoral heads with avacular necrosis (AVN). MATERIALS AND METHODS: We cultured human chondrocytes that were primarily derived from the articular cartilage of femoral heads with AVN. We evaluated the mRNA expression of type II collagen, aggrecan, VEGF-A and PEDF. RESULTS: The chondrocytes of the AVN group showed decreased expressions of type II collagen mRNA and aggrecan mRNA (p0.05). CONCLUSION: The cartilage matrix's formation ability was found to be decreased in the chondrocytes of the femoral heads affected by AVN.

Sliding after Internal Fixation of Stable Intertrochanteric Fracture of the Femur

PURPOSE: To evaluate the risk factors of sliding after internal fixation with sliding compression hip screw in stable intertrochanteric fracture of the femur. MATERIALS AND METHODS: From March 2000 to April 2003, 61 stable intertrochanteric fractures (Kyle-Gustilo type II) were treated operatively with sliding compression hip screws. The patients were 40 females and 21 males with an average age of 74 (range, 54~99). We measured vertical and horizontal shortening in regard to age, sex, bone mineral density, neck-shaft angle, cancellous bone defect, and the existence of lessor trochanter fracture on postoperative 6 months. RESULTS: The average vertical shortening was 4.1 mm (0~22 mm) and the average horizontal shortening was 7.3 mm (0~30 mm). Age, sex, bone density and neck-shaft angle were not significantly related with vertical and horizontal shortening (p>0.05). Vertical shortening was significantly greater in the group with cancellous bone defect and in the group without lesser trochanter fracture (p<0.05). CONCLUSION: Proper management for fracture site and fixation was needed to make it stable because the stable intertrochanteric fracture with cancellous bone defect and intact lesser trochanter could be induced into unexpected sliding.

Bilateral Bipartite Carpal Scaphoid: A Case Report / 대한정형외과학회잡지

Bipartite scaphoid is a rare anomaly and it has been questioned as whether it is of congenital origin or traumatic. However, many authors have reported that congenital origin is more probable. There was no case report in Korea about bipartite scaphoid, but this article reports a case of a 38-year-old male with bilateral bipartite scaphoid.

Effect of Displacement and Morphological Change of Medial Meniscus on Early Osteoarthritis of the Knee

PURPOSE: We investigated relationship between displacement and morphologic changes of medial meniscus and articular cartilage loss on magnetic resonance (MR) Images in early osteoarthritis of the knee. MATERIALS AND METHODS: Ninety-three cases with symptomatic knee and early osteoarthritis on the plain radiographs underwent MR imaging of the knee. We measured displacement, tear, and morphological changes of medial meniscus according to the amount of articular cartilage loss on coronal and sagittal MR images. RESULTS: The mean medial meniscal displacement was greater in cartilage loss group(4.3+/-2.8 mm) than control group(2.2+/-1.9 mm). The mean anterior meniscal displacement was greater in cartilage loss group (3.6+/-2.3 mm) than control group(1.9+/-1.2 mm). But meniscal displacement was not correlated with articular cartilage loss (p>0.05). The morphological changes of medial meniscus were 53.4%(31/58) in cartilage loss group and 11.4% (4/35) in control group (p<0.05). CONCLUSION: In early osteoarthritis of the knee, displacement and morphological changes of medial menisci had correlation with articular cartilage loss in MRI study.