Subtalar Distraction Arthrodesis Using Frozen Allobone Graft by Interpositional Structural / 대한족부족관절학회지

PURPOSE: Subtalar distraction arthrodesis is useful treatment option for restore hindfoot alignment. but, using structural autograft have high risk of donor site morbidity. Recently, by replacing the structural allograft has been reported satisfactory clinical results. Therefore, the authors reviewed the results of subtalar distraction arthrodesis using a structural allograft, retrospectively. MATERIALS AND METHODS: From January 2008 to May 2010, 12 patients (12 feets; 9 male, 3 female) underwent subtalar distraction arthrodesis using frozen structural allograft. 9 cases were calcaneal malunion, 2 were nonunion or malunion after subtalar arthrodesis, 1 was other cause. Mean age was 38.9 (12~66) years old and follow up period was 16.5 (12~36) months. Surgical was performed with posterolateral approach and tricortical allobone block of frozen femoral neck was used. Analysis was done with retorspective manner to evaluate preoperative, postoperative, and final follow up radiologic measurement and AOFAS ankle-hindfoot scale. RESULTS: There was statistically significant increase (p<0.05) of ankle-hindfoot scale from preoperative 27.5 points to postoperative 72.5 points, talocalcaneal height by 6.62 mm, calcaneal pitch angle by 5.73 degrees, lateral talocalcaneal angle by 6.38 degrees and significant decrease (p<0.05) of tali-1st metatarsal angle by 5.23 degrees. 11 feet (91.7%) acquired bony union and it takes average 5.1 months. Final post-operative result revealed talocalcaneal height changed by 2.57 mm, calcaneal pitch anble, lateral talocalcaneal angle, talar-1st metatarsal angle were changed by 2.63 degrees, 1.62 degrees, 1.18 degrees, respectively (p<0.05). 3 cases of partial osteonecrosis of posterior facet of calcaneus were observed in operation field, 4 cases of complication were developed (1 case of nonunion, 1 collapse of allobone graft, 1 screw loosening, 1 superficial skin necrosis). CONCLUSION: Subtalar distraction arthrodesis using frozen structural allobone graft is useful alternative treatment method of arthrodesis with structural autobone graft.

Experience of Splenic Artery Aneurysms

PURPOSE: Splenic artery aneurysm is uncommon, but the increased frequency in use of arteriography, computed tomography, and ultrasonography has resulted in increasing clinical recognition of these lesions. This paper relates our experience in the outcome and management of aneurysms of the splenic artery. METHODS: From January 1992 to October 1999, 12 patients were diagnosed with splenic artery aneurysms. They were retrospectively analyzed. RESULTS: The male to female ratio was 1:4 and the mean age was 46.3 years. The mean of pregnancy history of all women was 3.0 and there were no pregnant women during operation. The associated diseases that might have caused the aneurysms were pancreatitis in 5 patients, portal hypertension in 1, operative trauma in 1, and ill defined pathogenesis in 5 patients. The size of the aneurysms was larger than 2 cm in all patients. The splenic artery aneurysms was located at distal in 9 patients, mid in 1, and proximal in 2 patients. 7 patients were treated surgically (aneurysmectomy without splenectomy in 1 patient, aneurysmectomy with splenectomy in 6 patients). Transcatheter embolization was used in 4 patients. One of them was treated with distal pancreatectomy after two months because of pancreatic pseudocyst. One patient without treatment died 2 years after diagnosis. CONCLUSION: Although surgery remains necessary in splenic artery aneurysms larger than 2 cm, transcatheter embolization is effective in initial treatment of the high risk group in splenic artery aneurysms.