Treatment Results for Unstable Distal Clavicle Fractures Using Hybrid Fixations with Finger Trap Wire and Plate / 대한정형외과학회잡지

Purpose@#This study assessed the results of surgical treatment for Neer type-II and type-V unstable distal clavicle fractures via hybrid fixation with a locking compression plate and finger trap wire. @*Materials and Methods@#From September 2016 to April 2018, 15 patients treated for Neer type-II and type-V unstable distal clavicle fractures using hybrid fixation were analyzed retrospectively. The clinical results were analyzed based on the radiological healing time, range of motion of the shoulder joint, American Shoulder and Elbow Society (ASES) score, and the University of California at Los Angeles (UCLA) shoulder score. @*Results@#The range of motion of the shoulder joint completely recovered to the normal range within 9.2 weeks on average (6−24 weeks). Furthermore, the follow-up of the clinical trial showed excellent results, including an ASES score of 98.5±2.3 and an UCLA score of 34.2±1.3. In addition, fracture union was successfully achieved in all cases, and was identified during week 15 on average. @*Conclusion@#For the treatment of unstable distal clavicle fractures, hybrid fixation is a useful surgical method with excellent clinical outcomes through rapid recovery of the range of motion of the shoulder joint after surgery.

Ogilvie's Syndrome after Lumbar Spinal Surgery / 대한척추외과학회지

STUDY DESIGN: Case report. OBJECTIVES: We report a case of Ogilvie's syndrome following posterior decompression surgery in a spinal stenosis patient who presented with acute abdominal distension, nausea, and vomiting. SUMMARY OF LITERATURE REVIEW: Ogilvie's syndrome is a rare and potentially fatal disease that can easily be mistaken for postoperative ileus, and is also known as acute colonic pseudo-obstruction. Early recognition and diagnosis enable treatment prior to bowel perforation and requisite abdominal surgery. MATERIALS AND METHODS: An 82-year-old woman presented with 6 months of worsening back pain with walking intolerance due to weakness in both legs. She had hypertension, asthma, and Cushing syndrome without bowel or bladder symptoms. Further workup demonstrated the presence of central spinal stenosis on magnetic resonance imaging. The patient underwent an L2-3 laminectomy and posterior decompression. Surgery was uneventful. RESULTS: The patient presented with acute abdominal distension, nausea, and vomiting on postoperative day 1. The patient was initially diagnosed with adynamic ileus and treated conservatively with bowel rest, reduction in narcotic dosage, and a regimen of stool softeners, laxatives, and enemas. Despite this treatment, her clinical course failed to improve, and she demonstrated significant colonic distension radiographically. Intravenous neostigmine was administered as a bolus with a rapid and dramatic response. CONCLUSION: Ogilvie's syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after lumbar spinal surgery. Early diagnosis and initiation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.

Ogilvie's Syndrome after Lumbar Spinal Surgery

OBJECTIVES@#We report a case of Ogilvie's syndrome following posterior decompression surgery in a spinal stenosis patient who presented with acute abdominal distension, nausea, and vomiting.SUMMARY OF LITERATURE REVIEW: Ogilvie's syndrome is a rare and potentially fatal disease that can easily be mistaken for postoperative ileus, and is also known as acute colonic pseudo-obstruction. Early recognition and diagnosis enable treatment prior to bowel perforation and requisite abdominal surgery.@*MATERIALS AND METHODS@#An 82-year-old woman presented with 6 months of worsening back pain with walking intolerance due to weakness in both legs. She had hypertension, asthma, and Cushing syndrome without bowel or bladder symptoms. Further workup demonstrated the presence of central spinal stenosis on magnetic resonance imaging. The patient underwent an L2-3 laminectomy and posterior decompression. Surgery was uneventful.@*RESULTS@#The patient presented with acute abdominal distension, nausea, and vomiting on postoperative day 1. The patient was initially diagnosed with adynamic ileus and treated conservatively with bowel rest, reduction in narcotic dosage, and a regimen of stool softeners, laxatives, and enemas. Despite this treatment, her clinical course failed to improve, and she demonstrated significant colonic distension radiographically. Intravenous neostigmine was administered as a bolus with a rapid and dramatic response.@*CONCLUSION@#Ogilvie's syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after lumbar spinal surgery. Early diagnosis and initiation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.

Relationship between Lumbar Disc Degeneration and Back Muscle Degeneration / 대한척추외과학회지

STUDY DESIGN: Retrospective evaluation. OBJECTIVES: To determine the relationship between lumbar disc degeneration and back muscle degeneration. SUMMARY OF LITERATURE REVIEW: In the degenerative cascade of the spine described by Kirkaldy-Willis, degeneration of the disc and of the facet joint co-occur with aging. However, the muscles of the back are not included in this model. Several studies have reported significant correlations between back muscle degeneration and facet joint arthritis. The purpose of our study was to evaluate relationships between lumbar disc degeneration and fatty degeneration of the back muscles. MATERIALS AND METHODS: In this study, 65 patients over the age of 50 years who had undergone lumbar spine MRI in our orthopaedic clinic were recruited. Fatty degeneration of the back muscles was qualitatively graded from I to III by the degree of the fat signal in the muscle layer, including both the multifidus and erector spinae. Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. Correlations between the back muscle degeneration grade and radiological parameters were analyzed. RESULTS: The degeneration grade of the multifidus correlated positively with age and the grade of disc degeneration. Correlations with other radiologic parameters were not significant. The degeneration grade of the erector spinae correlated positively with age. Other radiologic parameters were not significant. CONCLUSIONS: There was a significant correlation between lumbar disc degeneration and multifidus degeneration. Erector spinae degeneration was correlated with age, but not with lumbar disc degeneration. The degenerative cascade of the spine was accompanied by fatty changes of the multifidus with aging.

The Effect of Cervical Lordosis on Cervical Disc Degeneration in Patients with a High T1 Slope / 대한척추외과학회지

STUDY DESIGN: Retrospective evaluation. OBJECTIVES: To analyze the effect of cervical lordosis on cervical disc degeneration in patients with a high T1 slope. SUMMARY OF LITERATURE REVIEW: The T1 slope is known to be a parameter that may be very useful in evaluating sagittal balance. We previously reported that a low T1 slope was a potential risk factor for cervical spondylosis, especially in the C6–7 cervical segment. However, no study has analyzed the effect of cervical lordosis in patients with a high T1 slope (>25) on cervical disc degeneration. MATERIALS AND METHODS: Seventy-seven patients with a high T1 slope who underwent cervical spine MRI in our orthopedic clinic were enrolled. Patients were divided into 2 groups according to cervical compensation. The radiologic parameters obtained from radiography and cervical spine MRI were compared between the uncompensated group (cervical lordosis <25) and the compensated group (cervical lordosis ≥25). RESULTS: In the uncompensated group, the average degeneration grade of each segment was 2.72 (±0.70) in C2–3, 3.00 (±0.76) in C3–4, 3.02 (±0.91) in C4–5, 3.37 (±0.95) in C5–6, and 2.95 (±0.98) in C6–7. The average degeneration grade of each segment in the compensated group was 2.38 (±0.78) in C2–3, 2.38 (±0.60) in C3–4, 2.62 (±0.60) in C4–5, 2.82 (±0.72) in C5–6, and 2.41 (±0.74) in C6–7. The degeneration grade was significantly higher in the uncompensated group than in the compensated group for all cervical segments. The risk of high-grade degeneration of C3–4 was significantly higher in the uncompensated group (odds ratio = 6.268; 95% CI, 2.232–17.601; p<.001). CONCLUSIONS: Patients with a high T1 slope without compensation of cervical lordosis had a higher grade of degeneration in all cervical segments.

Relationship between Lumbar Disc Degeneration and Back Muscle Degeneration

OBJECTIVES@#To determine the relationship between lumbar disc degeneration and back muscle degeneration.SUMMARY OF LITERATURE REVIEW: In the degenerative cascade of the spine described by Kirkaldy-Willis, degeneration of the disc and of the facet joint co-occur with aging. However, the muscles of the back are not included in this model. Several studies have reported significant correlations between back muscle degeneration and facet joint arthritis. The purpose of our study was to evaluate relationships between lumbar disc degeneration and fatty degeneration of the back muscles.@*MATERIALS AND METHODS@#In this study, 65 patients over the age of 50 years who had undergone lumbar spine MRI in our orthopaedic clinic were recruited. Fatty degeneration of the back muscles was qualitatively graded from I to III by the degree of the fat signal in the muscle layer, including both the multifidus and erector spinae. Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. Correlations between the back muscle degeneration grade and radiological parameters were analyzed.@*RESULTS@#The degeneration grade of the multifidus correlated positively with age and the grade of disc degeneration. Correlations with other radiologic parameters were not significant. The degeneration grade of the erector spinae correlated positively with age. Other radiologic parameters were not significant.@*CONCLUSIONS@#There was a significant correlation between lumbar disc degeneration and multifidus degeneration. Erector spinae degeneration was correlated with age, but not with lumbar disc degeneration. The degenerative cascade of the spine was accompanied by fatty changes of the multifidus with aging.

The Effect of Cervical Lordosis on Cervical Disc Degeneration in Patients with a High T1 Slope

OBJECTIVES@#To analyze the effect of cervical lordosis on cervical disc degeneration in patients with a high T1 slope.SUMMARY OF LITERATURE REVIEW: The T1 slope is known to be a parameter that may be very useful in evaluating sagittal balance. We previously reported that a low T1 slope was a potential risk factor for cervical spondylosis, especially in the C6–7 cervical segment. However, no study has analyzed the effect of cervical lordosis in patients with a high T1 slope (>25) on cervical disc degeneration.@*MATERIALS AND METHODS@#Seventy-seven patients with a high T1 slope who underwent cervical spine MRI in our orthopedic clinic were enrolled. Patients were divided into 2 groups according to cervical compensation. The radiologic parameters obtained from radiography and cervical spine MRI were compared between the uncompensated group (cervical lordosis <25) and the compensated group (cervical lordosis ≥25).@*RESULTS@#In the uncompensated group, the average degeneration grade of each segment was 2.72 (±0.70) in C2–3, 3.00 (±0.76) in C3–4, 3.02 (±0.91) in C4–5, 3.37 (±0.95) in C5–6, and 2.95 (±0.98) in C6–7. The average degeneration grade of each segment in the compensated group was 2.38 (±0.78) in C2–3, 2.38 (±0.60) in C3–4, 2.62 (±0.60) in C4–5, 2.82 (±0.72) in C5–6, and 2.41 (±0.74) in C6–7. The degeneration grade was significantly higher in the uncompensated group than in the compensated group for all cervical segments. The risk of high-grade degeneration of C3–4 was significantly higher in the uncompensated group (odds ratio = 6.268; 95% CI, 2.232–17.601; p<.001).@*CONCLUSIONS@#Patients with a high T1 slope without compensation of cervical lordosis had a higher grade of degeneration in all cervical segments.

Medial Meniscal Root Repair Using Curved Guide and Soft Suture Anchor

Medial meniscal root tears have been repaired using various methods. Arthroscopic all-inside repair using a suture anchor is one of the popular methods. However, insertion of the suture anchor into the proper position at the posterior root of the medial meniscus is technically difficult. Some methods have been reported to facilitate suture anchor insertion through a high posteromedial portal, a posterior trans-septal portal, or a medial quadriceptal portal. Nevertheless, many surgeons still have difficulty during anchor insertion. We introduce a technical tip for easy suture anchor insertion using a 25° curved guide and a soft suture anchor through a routine posteromedial portal.

Relationship Between Pelvic Tilt and Lumbar Disc Degeneration

STUDY DESIGN: Retrospective analysis. OBJECTIVES: To determine the relationship between pelvic tilt and lumbar disc degeneration. SUMMARY OF LITERATURE REVIEW: The shape and the spatial orientation of the pelvis determine the organization of the lumbothoracic spine. The purpose of our study was to determine the relationship between pelvic tilt and lumbar disc degeneration. MATERIALS AND METHODS: Sixty patients over 50 years of age who had undergone lumbar spine magnetic resonance imaging were recruited. In individuals between 41 and 60 years of age, the normal pelvic tilt is 14°. Patients were divided into a low pelvic tilt (PT) group (<14°) and a high pelvic tilt (PT) group (≥14°). Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. We defined grades IV and V as high-grade degeneration and the others as low-grade degeneration. Radiologic parameters and lumbar disc degeneration were compared between these 2 groups. RESULTS: In the low PT group, the average degeneration grade of each lumbar segment was 2.61 in L1-L2, 2.61 in L2-L3, 3.00 in L3-L4, 3.39 in L4-L5, and 3.84 in L5-S1. The corresponding grades in the high PT group were 2.34 in L1-L2, 2.62 in L2-L3, 3.07 in L3-L4, 3.76 in L4-L5, and 3.55 in L5-S1. The grade of degeneration of the high PT group was significantly higher than that of the low PT group for L4-L5 (p=0.031). High-grade degeneration of the L4-L5 segment was significantly more common in the high PT group (odds ratio=4.65; 95% CI, 1.406-15.381; p=0.012). CONCLUSIONS: Patients with high pelvic tilt had a higher grade of lumbar disc degeneration in the L4-L5 segment regardless of age or gender.

Risk Factors for Osteoporotic Vertebral Fracture in Cushing Syndrome

STUDY DESIGN: Retrospective study. OBJECTIVES: The goal of this study was to evaluate the risk factors of osteoporotic vertebral fractures (OVFs) in patients with Cushing syndrome. SUMMARY OF LITERATURE REVIEW: In most reports, vertebral fractures in Cushing syndrome have been found to be related to osteoporosis. However, few studies have analyzed the clinical risk factors for OVFs. MATERIALS AND METHODS: Thirty-two patients with Cushing syndrome who visited the orthopaedic department complaining of back pain were included in this study. Standing lateral X-rays were performed to evaluate the presence of vertebral fractures, and bone mineral density (BMD) was measured. RESULTS: Of the 32 patients with Cushing syndrome with back pain, 8 (25%) were diagnosed with OVFs using morphometric criteria. The average weight and body mass index of the vertebral fracture group (VF group) were significantly higher than the values observed in the non-vertebral fracture group (non-VF group) (p=0.004, p=0.018). Lumbar BMD was significantly lower in the VF group (p=0.006). A risk factor for OVFs in Cushing syndrome was osteoporosis (odds ratio=18.56, 95% confidence interval=1.72-200.21, p=0.016) regardless of gender, obesity, menopause, or urine free cortisol levels. CONCLUSIONS: OVFs in Cushing syndrome have been associated with overweight, and overweight is an indicator of compliance in the treatment of Cushing syndrome. Therefore, weight reduction and the prevention of osteoporosis should be emphasized in patients with Cushing syndrome to prevent OVFs.

The Results of Proximal Femoral Nail for Intertrochanteric Fracture in Hemodialysis Patient / 대한고관절학회지

PURPOSE: Hip fractures in hemodialysis patients are accompanied by high rates of complications and morbidities. Previous studies have mainly reported on nonunion and avascular necrosis of femoral neck fractures in this patient group. In this study the complication and clinical results of hemodialysis patients with intertrochanteric fractures treated with proximal femoral intramedullary nailing have been investigated through comparison with patients with normal kidney function. MATERIALS AND METHODS: Forty-seven patients were included; the hemodialysis group (n=17) and the control group with normal kidney function (n=30). The medical history and clinical findings including preoperative and postoperative blood examinations, radiological examinations and ambulatory status (measured using the Koval score). The rate of complications and morbidities were also investigated and compared. RESULTS: Preoperative hemoglobin/hematocrit was lower but a significant increase in partial thromboplastin time was observed in the hemodialysis group. The amount of bleeding/transfusions were higher and operative time was longer in the hemodialysis group. Upon radiologic examination, there was no significant difference in rate of unstable fracture and nonunion between the two groups. However the postoperative Koval score was significantly worse and the odds ratio of inability to walk after surgery was 13.5 times higher in the hemodialysis group. CONCLUSION: There was no significant difference in radiological results, but the risk of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Hemodialysis patients have more morbidities and are hemodynamically unstable therefore require special attention. Accurate reduction and firm fixation is required and attentive postoperative rehabilitation is needed.

Effect of Smoking on Osteoporotic Vertebral Fracture in Postmenopausal Women

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the association between smoking and osteoporotic vertebral fractures (OVFs) in postmenopausal women. SUMMARY OF LITERATURE REVIEW: Several studies have examined the relationship of smoking with hip fractures, but few studies have analyzed the relationship of smoking with spine fractures in women thus far. MATERIALS AND METHODS: This study considered 1255 postmenopausal women aged 50 years and older (enrollment from April 2008 to January 2009) from 62 study sites in a nationwide hospital. The amount of smoking was calculated in pack-years. Further, OVFs were diagnosed using a semi-quantitative method. To analyze the relationship between smoking and OVFs, we used a paired t-test, a χ2-test, and a binary logistic regression analysis. RESULTS: The past history of smoking was 7.2% in the patient group and 4.3% in the control group (p=0.025). The mean pack-years of smoking was 0.34 in the control group and 0.62 in the patient group (p=130). The mean T-score in the lumbar bone mass density (BMD) was –1.64 in the control group and –2.19 in the patient group (p=0.409). Smoking was a risk factor of vertebral fractures in postmenopausal women (odd's ratio=1.68, 95% confidence interval=1.020–2.759, p=0.042) irrespective of the lumbar BMD and the medical treatment for osteoporosis and obesity. CONCLUSIONS: Smoking is a risk factor for osteoporotic vertebral fractures in postmenopausal women independently without regard to lumbar BMD. Therefore, cessation of smoking is important for the prevention of OVFs in postmenopausal women.

Surgical Management of Comminuted Avulsion Fracture of the Proximal Fibula with Lateral Collateral Ligament Injury: Technical Note

Anteromedial force to the knee in an extended position can cause an avulsion fracture of the proximal fibula with combined injuries to the posterolateral ligaments. Avulsion fractures of the proximal fibula are rare and current management of these fractures is based on few descriptions in literature. Various surgical methods of fixation for these fractures have been reported, but there is still no standard treatment modality. Anatomic reduction of these fractures is technically difficult, and failure of reduction may cause posterolateral instability, secondary arthritis and other complications. We present our experience with two such cases of comminuted avulsion fractures of the proximal fibular with posterolateral ligament ruptures surgically fixated with a locking compression hook plate and non absorbable sutures.

Treatment of Lateral Malleolar Fracture Associated with Disruption of the Deltoid Ligament / 대한정형외과학회잡지

PURPOSE: To evaluate the necessity for repair of associated deltoid ligament rupture in lateral malleolar fracture. MATERIALS AND METHODS: Twenty of twenty-five patients were evaluated. Each received surgical treatment without repair of the ruptured deltoid ligament. We found that the medial clear space was widened more than 5 mm in intraoperative stress tests which had been done between May 2003 and June 2008. We did follow-up on these patients for more than 1 year after surgery. At the final follow-up, radiologic and clinical assessment were evaluated on plain X-ray and according to Olerud Molander ankle scores. RESULTS: Open reduction and internal fixation of the lateral malleolar was done in all cases and an additional transfixation screw was needed in 17 patients who had concurrent syndesmotic disruption. Average medial clear space widening before surgery was 9.28 mm (7.0-17.14 mm), at final follow-up time it was 3.43 mm (2.9-5.28 mm). And there were 8 (40%) good, 10 (50%) fair and 2 (10%) poor ratings on radiologic evaluation, but the mean clinical score was 93.75, with 17 (85%) being excellent, 2 (10%) good and 1 (5%) fair on clinical evaluation. CONCLUSION: In the treatment of lateral malleolus fracture associated with disruption of the deltoid ligament, satisfactory clinical results could be obtained including lateral joint stability, with accurate anatomical reduction and internal fixation of the lateral malleolus and distal tibio-fibular joints. Medial joint stability could be obtained without deltoid ligament repair.

Surgical Treatment of Symptomatic Accessory Navicular in Adolescent / 대한족부족관절학회지

PURPOSE: To investigate the results of surgical treatment of the symptomatic accessory navicular in adolescent. MATERIALS AND METHODS: 11 patients who were 11~16 years old with symptomatic accessory navicular were identified between 2001 and 2009. Six cases were diagnosed after trauma and 8 cases were diagnosed by accident with painful bony protrusion on medial aspect of foot. In cases after at least 3 months of ineffective conservative treatment, patients were treated by resection of accessory navicular and reattachment of tibialis posterior tendon to the apex of the medial longitudinal arch using periosteum and ligamentous soft tissue without transposition of its course. And then short leg cast was applied for correction of the flat foot (if it is combined) which was molded into the longitudinal arch with the talonavicular joint released and foot inverted during about 6 weeks. RESULTS: All were type II accessory navicular without tibialis posterior tendon lesions. In most cases pain was improved, results were excellent in seven and good in four. Calcaneal pitch angle and talus-first metatarsal angle was improved about 4.64degrees and 5.79degrees in average. CONCLUSION: Symptomatic accessory navicular in adolescent might not be associated with the tibialis posterior tendon lesions. The surgical treatment composed of excision of the accessory navicular with simple replication of the tibialis posterior tendon without altering its course led to good results in most cases. The procedure has a low rate of complications. And it is easy to be performed with a good satisfaction.

Surgical Treatment of Symptomatic Accessory Navicular in Adolescent / 대한족부족관절학회지

PURPOSE: To investigate the results of surgical treatment of the symptomatic accessory navicular in adolescent. MATERIALS AND METHODS: 11 patients who were 11~16 years old with symptomatic accessory navicular were identified between 2001 and 2009. Six cases were diagnosed after trauma and 8 cases were diagnosed by accident with painful bony protrusion on medial aspect of foot. In cases after at least 3 months of ineffective conservative treatment, patients were treated by resection of accessory navicular and reattachment of tibialis posterior tendon to the apex of the medial longitudinal arch using periosteum and ligamentous soft tissue without transposition of its course. And then short leg cast was applied for correction of the flat foot (if it is combined) which was molded into the longitudinal arch with the talonavicular joint released and foot inverted during about 6 weeks. RESULTS: All were type II accessory navicular without tibialis posterior tendon lesions. In most cases pain was improved, results were excellent in seven and good in four. Calcaneal pitch angle and talus-first metatarsal angle was improved about 4.64degrees and 5.79degrees in average. CONCLUSION: Symptomatic accessory navicular in adolescent might not be associated with the tibialis posterior tendon lesions. The surgical treatment composed of excision of the accessory navicular with simple replication of the tibialis posterior tendon without altering its course led to good results in most cases. The procedure has a low rate of complications. And it is easy to be performed with a good satisfaction.

Double Tension Band Wire Fixation for Unstable Fracture of the Distal Clavicle

PURPOSE: To evaluate the clinical results after operative treatment with the double tension band wire fixation in Neer type II and III distal clavicle fractures. MATERIALS AND METHODS: Ten patients with type II and III distal clavicle fractures were evaluated, who operated with double tension band wire fixation technique, from Febrary 2007 to June 2008, and could be followed-up for more than 1 year after operation. Postoperative assessments were evaluated on plain x-ray, pain, and clinical finding according to the functional criteria by Kona et al. RESULTS: Average duration from operation to fracture union was 8 weeks in all cases. There were 8 excellent and 2 good results. It was no other significant complications such as K-wire migration, breakage, infection, and AC joint arthritis. CONCLUSION: Double tension band wire fixation technique seems to be an effective method for type II or III distal clavicle fracture with multiple compressive axis, without injury of the AC joint and loosening of the fixation.

Idiopathic Osteonecrosis of the Patella: A Case Report / 대한정형외과학회잡지

It is important to recognize idiopathic osteonecrosis or avascular necrosis of the patella not only because of its rarity but because a majority of the patients remain asymptomatic without treatment. The etiology of osteonecrosis is unclear. Certain conditions and diseases have been associated with osteonecrosis of the patella including the systemic administration of steroids, a fracture of the patella, a total knee arthroplasty and other traumatic conditions. The diagnosis is usually made with radiographs, MR imaging and a radioisotopic bone scan. It is believed to have a benign course and a favorable prognosis. We report for the first time in Korea a patient with idiopathic osteonecrosis diffusely involving the whole patella without any obvious cause.

The Results of Modified Brostrom Procedure for the Treatment of Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: This study was performed to evaluate clinical and radiographical results of treatment of chronic lateral ankle instability with modified Brostrom procedure. MATERIALS AND METHODS: This is a retrospective study of 22 cases in 22 patients treated with modified Brostrom procedure under the diagnosis of chronic lateral ankle instability from May 2000 to August 2004. Average age was 32.3 years. Average follow-up period was 23 months. Preoperative and postoperative radiographs of ankle anteroposterior view, lateral view and varus stress view were analyzed. The clinical evaluation was performed according to the Americal Orthopaedic Foot and Ankle Society scales. RESULTS: After the modified Brostrom procedure, Americal Orthopaedic Foot and Ankle Society scales score was improved by average 28 points. Among the 22 cases, 13 cases were excellent, 3 cases good, 4 cases fair, and 2 cases poor with satisfaction of 73%. Five cases had intermittent ankle pain of whom 3 cases had difficulty during competitive sports activity. Lateral tilting of talus improved by average 5.4 degrees on varus stress view. CONCLUSIONS: The modified Brostrom procedure is one of the most effective methods for treating of chronic lateral ankle instability.

Cementless Zweymuller Stem for the Treatment of the Hip Fracture in Patients Older than 80 with Severe Osteoporosis: Case Control Study with Cemented Stem

PURPOSE: We tried to evaluate the usefulness of the cementless Zweymuller stem for treating hip fracture in those patients older than 80 years with severe osteoporosis. MATERIALS AND METHODS: Thirty cases were treated with bipolar hemiarthroplasty with a cementless Zweymuller stem and they served as group I (the study group), and 30 cases treated with a cemented stem served as group II (the control group). We performed a comparative study between the two groups. RESULTS: The admission period (days) was 24.6+/-10.7 and 32.8+/-16.8 (p=0.047) for the 2 groups, respectively, and the average operation time (minutes) was 75.8+/-17.6 and 89.2+/-28.1 (p=0.024), respectively; the total blood loss (ml) was 457.2 and 548.3 (p=0.035) in group I and II, respectively. The incidence of staying in the intensive care unit (ICU) and the average time to start postoperative ambulation showed no significant differences between the two groups. Pulmonary embolism occurred in 1 case in group I and in 4 cases in group II, and intraoperative fracture of calcar occurred in 2 cases of group I. There was no case of position change of the femoral stem at 1 year postoperatively in both groups. CONCLUSION: The cementless Zweymuller stem, inserted by press fit in the patients who are older than 80 years and who have hip fracture with severe osteoporosis showed clinically better results as compared with the cemented stem.