Necrotizing Soft-Tissue Infections: A Retrospective Review of Predictive Factors for Limb Loss

Background@#Emergent diagnosis and treatment are important for the survival of patients with necrotizing soft-tissue infections (NSTIs). Death is the most catastrophic outcome, but limb loss is also one of the most important complications that can have a significant impact on the rest of the patient’s life. The purpose of this study was to identify predictive factors for limb loss caused by NSTIs. @*Methods@#The data of patients at our center who were diagnosed with NSTIs from May 2003 to January 2019 were analyzed retrospectively. The inclusion criteria were patients with a definite diagnosis of NSTI involving the upper or lower limb. A total of 49 patient records were analyzed in terms of demography, laboratory data, microbiological causes, treatment, and final outcome. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scores at initial admission were also collected as laboratory data. Final outcomes were classified into survival with limb salvage and survival with limb loss. @*Results@#The limb loss rate was 20.4% (10/49) in our study. On comparison between the limb salvage group and the limb loss group, independent risk factors of limb loss were as follows: presence of hypotension at admission (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.7–38.3; p = 0.008); LRINEC score ≥ 9 (OR, 5.8; 95% CI, 1.3–25.6; p = 0.012), and glucose level > 300 mg/dL (OR, 4.5; 95% CI, 0.9–21.9; p = 0.041). Various microbiological organisms were isolated; the most prevalent specimen was streptococci (32.6%), followed by staphylococci (26.5%). Poor outcomes including limb loss and mortality had no correlation with microbiological organisms. @*Conclusions@#For patients with NSTIs, the presence of hypotension at admission, a high glucose level (> 300 mg/dL), and a high LRINEC score (> 9) were independent risk factors for limb loss.

The Efficacy of Suture Fixation of the Greater Trochanter in Unstable Intertrochanteric Fractures

Background@#Intertrochanteric fractures are one of the most common fractures in the elderly, especially those having osteoporosis. Stable intertrochanteric fractures may be fixed with implants including the dynamic hip screw and proximal femoral nail antirotation; however, this method is difficult to apply to unstable fractures. Bipolar hemiarthroplasty can be applied to unstable fractures and it prevents complications by facilitating early ambulation in the elderly. Many studies reported on how to fix the greater trochanter in unstable fractures during arthroplasty. We suggest that suture fixation alone can be a useful, effective, and affordable method. @*Methods@#We retrospectively enrolled 294 patients who underwent hemiarthroplasty for an unstable intertrochanteric fracture, and 225 patients were included in this study after excluding 69 patients who had not been available for follow-up until 1 year after surgery or died. The patients were divided into suture fixation and wiring fixation groups. Relationships of operation time, estimated blood loss, tip-to-stem distance, union rate, and physical performance in the groups of suture fixation and wiring were analyzed respectively. @*Results@#Changes in the tip-to-stem distance between the initial assessment at 1 year after surgery were statistically significantly different between the suture fixation group and wiring group (p < 0.001). There was no significant difference in change of the Koval score between the suture fixation and wiring groups (p = 0.362). The operation time and estimated intraoperative blood loss were statistically significantly lower in the suture group than in the wiring group (p < 0.001). There was no significant difference in the union rate between the groups (p = 0.470). @*Conclusions@#Compared to tension-band wiring, the suture fixation technique demonstrated an effective fixing force. In addition to the clinical results, it had an advantage of preventing complications due to shortening of the operation time and estimated intraoperative blood loss. Suture fixation of the greater trochanter is recommended for elderly patients with unstable intertrochanteric fractures.

Clinical Study on Safety, Clinical Indicators of Polydioxanone Sutures Inserted into Vastus Medialis Muscle in Degenerative Knee Osteoarthritis

Objective@#Physiologically, the vastus medialis muscle is the first muscle to undergo muscle atrophy, and it was thought that pain in patients with knee osteoarthritis could be reduced if this muscle could be strengthened and stabilized. The purpose of this study was to prove the effectiveness in knee osteoarthritis using polydioxanone sutures that have been tried in other musculoskeletal areas. Method: Forty knee osteoarthritis patients voluntarily participated in the study, and divided into 30 polydioxanone suture needle (MEST-B2375 produced by Ovmedi Co.) and 10 sham needle (without suture). And the needles were inserted into the vastus medialis muscle. In all patients, safety evaluation including blood tests and ultrasonography as well as efficacy evaluation including isometric maximal contractile strength of quadriceps muscle, weight bearing pain, impression of change, quadriceps angle, rescue drug intake were evaluated up to 30 weeks after the procedure. @*Results@#Isometric maximal contractile strength showed a significant improvement at 4 weeks after the procedure in the polydioxanone suture group, and the weight-bearing pain showed a significant improvement at every visit in the polydioxanone suture group compared with baseline values. Patient global impression of change score showed significant improvement at 20 and 30 weeks, and clinical score showed improvement at every visit. @*Conclusion@#Insertion of polydioxanone sutures showed improvement in muscle strength and knee pain by supporting and fixation of the vastus medialis muscle in patients with degenerative knee osteoarthritis. Insertion of polydioxanone sutures is considered to have a therapeutic effect in knee osteoarthritis patients.

Influence of posteromedial corner injuries on clinical outcome and second-look arthroscopic findings after allograft transtibial anterior cruciate ligament reconstruction

Background@#The purpose of this study was to evaluate the influence of posterior medial corner (PMC) injuries on clinical outcome and second-look arthroscopic findings after anterior cruciate ligament (ACL) reconstruction. @*Methods@#Seventy-eight consecutive patients underwent a second-look arthroscopic surgery after ACL reconstruction and magnetic resonance imaging (MRI) examination of the PMC. The patients were divided into a PMC intact group (n = 42) and a PMC injured group (n = 36). The stability and clinical outcomes were evaluated using the Lachman test, pivot-shift test, a KT-2000 arthrometer, and the Lysholm knee scoring scale. Graft tension and synovial coverage were evaluated in second-look arthroscopy. @*Results@#The clinical function showed no significant differences regarding PMC injury. Although the graft tendon tension revealed no significant differences (p = 0.141), the second-look arthroscopic findings indicated that the PMC intact group showed better synovial coverage compared to the PMC injured group (p = 0.012). @*Conclusion@#Patients who injured the PMC had poor synovial coverage as assessed by second-look arthroscopic findings after transtibial ACL reconstruction, even though clinical outcomes and stability showed no significant differences.

Results after Less Invasive Locking Plating in Intra-Articular Fractures of the Distal Femur

PURPOSE: The purpose of this study was to determine the clinical outcomes after a less invasive locking plating technique in intra-articular fractures of the distal femur. MATERIALS AND METHODS: This was a retrospective 19 case series of patients with distal femoral intraarticular fractures treated with a less invasive locking plating technique in a single center (Dankook University Hospital) from June 2010 to April 2016. Nineteen patients (11 males and 8 females) with a mean age of 55.9 years were enrolled. The functional outcomes were evaluated using the visual analogue scale (VAS), range of knee joint motion (flexion & extension), and Knee Society score. The radiology outcomes were evaluated with parameters measured in a plain radiograph (deviation angle of alignment axis on coronal and sagittal plane, mechanical lateral distal femur angle). RESULTS: The mean follow-up period was 26.4 months (range, 12–72 months) and the mean duration to union was 15.94 weeks (range, 11–28 weeks). The mean VAS was 1.36 (range, 0–8) and the range of motion of the knee joint was extension 4.73° (range, 0°–30°) and flexion 107.36° (range, 60°–135°). The mean Knee Society score was 85.47 (range, 47–100). The mean deviation angle of the coronal alignment axis was 4.07° (range, 1.3°–8.8°), the mean deviation angle of the sagittal alignment axis was 3.23° (range, 0.7°–7.0°), and the mechanical lateral femoral angle was 87.75° (range, 82.8°–95.5°). Six patients had traumatic osteoarthritis at the final follow-up. CONCLUSION: The purpose of this study was to evaluate the clinical and radiologic outcomes of intraarticular fractures of the distal femur in patients who underwent an anatomical reduction through an open reduction, and converted to an extra-articular fracture with rigid internal fixation. The results were relatively satisfactory.

Essential Factors in Predicting the Need for Angio-Embolization in the Acute Treatment of Pelvic Fracture with Hemorrhage

PURPOSE@#The purpose of this study was to determine the essential factors for prompt arrangement of angio-embolization in patients with pelvic ring fractures.@*METHODS@#A total of 62 patients with pelvic ring fractures who underwent angioembolization in Dankook University Hospital from March 2013 to June 2018 were retrospectively reviewed. There were 38 men and 24 women with a mean age of 59.8 years. The types of pelvic ring fractures were categorized according to the Tile classification. Patient variables included sex, initial hemoglobin concentration, initial systolic blood pressure, transfused packed red blood cells within 24 hours, Injury Severity Score (ISS), mortality rate, length of hospital stay, and time to angio-embolization.@*RESULTS@#The most common pelvic fracture pattern was Tile type B (n=34, 54.8%). The mean ISS was 27.3±10.9 with 50% having an ISS ≥25. The mean time to angio-embolization from arrival was 173.6±89 minutes. Type B (180.1±72.3 minutes) and type C fractures (174.7±91.3 minutes) required more time to angio-embolization than type A fractures (156.6±123 minutes). True arterial bleeding was identified in types A (35.7%),B (64.7%), and C (71.4%).@*CONCLUSIONS@#It is important to save time to reach the angio-embolization room in treating patients with pelvic bone fractures. Trauma surgeons need to consider prompt arrangement of angio-embolization when encountering Tile type B or C pelvic fractures due to the high risk of true arterial bleeding.

Bilateral Asymmetric Traumatic Dislocation of the Hip Joint

Traumatic hip joint dislocations account for 2–5% of total joint dislocations. Bilateral asymmetric hip joint dislocation with anteriorly and posteriorly dislocation is an even more rare case because it was according to G. Loupasis reported in 11 cases only since 1879. We want to report 2 cases of bilateral asymmetric hip joint dislocation with unilateral acatabulum fracture which happened in our hospital. Bilateral asymmetric dislocation of hip joint accompanied by unilateral fracture of acetabulum is a very rare case so statistical verification cannot be done. However, close examinations are required at early treatment and follow-up because the patterns of dislocation and fracture of hip joint are variable and an orthopedic emergent condition and several complications may occur at both hip joints.

Glomus Tumor Causing Knee Pain / 대한정형외과학회잡지

Glomus tumor is a kind of hemangioma that occurs at the glomerulus in the subcutaneous layer. It mainly occurs at the distal hand and subungual area, and rarely at the knee joint. Pain, tenderness, and cold intolerance are known symptoms; however, symptoms in practice are not so easily detectable, and the diagnosis can be delayed if it is presented at areas other than the hand. If the diagnosis is delayed, patients could suffer extreme pain. Therefore, early diagnosis and surgical treatment are important. Ultrasound and magnetic resonance imaging were used to diagnose glomus tumor in our cases, which were found in subcutaneous tissue and muscle fascia. We claim that, for patients with persistent pain, known symptoms—extreme pain, cold intolerance, and tenderness—should be examined carefully and rule out glomus tumor. We report 2 cases of glomus tumors around the knee joint, which is not a common location of occurrence.

The Cause of Primary Reduction Failure in Hip Dislocation with or without Hip Fracture

PURPOSE: A rapid and accurate reduction is important for hip dislocated patients to avoid various potential complications, including avascular necrosis of the femoral head. We analyzed hip dislocation cases, ones that particularly failed during the primary reduction trial. MATERIALS AND METHODS: Eighty-seven patients with hip dislocation, who visited the emergency department between January 2007 and September 2015, were retrospectively analyzed. Of them, 68 patients were successfully treated in the first closed reduction trial, and the remaining 19 patients were unsuccessful. Of the 19 unsuccessful first trial, 12 patients were successfully treated in the second closed reduction; however, in the remaining 7 patients, open reduction was performed in the operation room with general anesthesia. Every closed reduction was practiced by at least 2 orthopedic doctors, and open reduction was performed by a single senior author. RESULTS: The rate of first reduction failure was higher, with statistical significance, in patients aged under 50 years, male gender, and those with combined around hip fractures, including femoral head and acetabular fracture (p0.05). CONCLUSION: To evaluate the patients with hip dislocation, realizing the type of dislocation, presence of accompanied fracture, location and size of fracture fragment, age, as well as gender of patients is important. If the fracture fragment is impacted in the hip joint and the size of the fragment is large, then the operative treatment is considered, rather than the repetitive trial of closed reduction by constraint.

The Cause of Primary Reduction Failure in Hip Dislocation with or without Hip Fracture

PURPOSE: A rapid and accurate reduction is important for hip dislocated patients to avoid various potential complications, including avascular necrosis of the femoral head. We analyzed hip dislocation cases, ones that particularly failed during the primary reduction trial. MATERIALS AND METHODS: Eighty-seven patients with hip dislocation, who visited the emergency department between January 2007 and September 2015, were retrospectively analyzed. Of them, 68 patients were successfully treated in the first closed reduction trial, and the remaining 19 patients were unsuccessful. Of the 19 unsuccessful first trial, 12 patients were successfully treated in the second closed reduction; however, in the remaining 7 patients, open reduction was performed in the operation room with general anesthesia. Every closed reduction was practiced by at least 2 orthopedic doctors, and open reduction was performed by a single senior author. RESULTS: The rate of first reduction failure was higher, with statistical significance, in patients aged under 50 years, male gender, and those with combined around hip fractures, including femoral head and acetabular fracture (p0.05). CONCLUSION: To evaluate the patients with hip dislocation, realizing the type of dislocation, presence of accompanied fracture, location and size of fracture fragment, age, as well as gender of patients is important. If the fracture fragment is impacted in the hip joint and the size of the fragment is large, then the operative treatment is considered, rather than the repetitive trial of closed reduction by constraint.

The Efficacy and Safety of Autologous Transfusion in Unilateral Total Knee Arthroplasty

PURPOSE: Although allogeneic blood transfusion is the most common method of transfusion in total knee arthroplasty (TKA), there are reports showing significant decrease in the amount of allogeneic transfusion and incidence of side effects after combined use of autologous transfusion. The purpose of this study is to investigate the efficacy of using an autologous transfusion device in TKA. MATERIALS AND METHODS: Patients who underwent TKA at our institution from January 2003 to January 2014 were divided into two groups: group A (n=127) who received allogeneic transfusion only in TKA and group B (n=118) who received autologous transfusion via an autologous transfusion device and allogeneic transfusion. In both groups, the patients were transfused when the hemoglobin level was below 9 g/dL. In group B, blood collected by the autologous transfusion device was transfused only once after surgery. The total blood loss volume, total transfusion volume, and the presence of side effects were assessed based on medical records. RESULTS: Group A received 294.6 mL more allogeneic transfusion than group B (p<0.001). There were no significant differences with regard to the development of side effects between groups. CONCLUSIONS: Application of an autologous transfusion device during TKA can be effective in reducing the allogeneic transfusion volume. Moreover, allogeneic transfusion was not necessary after autologous transfusion in some patients.

Meloxicam-induced Erythema Multiforme / 대한정형외과연구학회지

Erythema multiforme is an acute cutaneous reaction which manifests as macular patches and edematous papules commonly involving the hands, feet, forearm and mucous membranes. It is thought to be caused by viral and bacterial infections, neoplasms, autoimmune diseases such as rheumatoid arthritis, and also by pharmaceuticals such as sulfonamides, phenytoin, barbiturates, penicillins, carbamazepines. Nonsteroidal antiinflammatory drugs (NSAIDs) have been also reported as a possible cause. However, meloxicam that is a kind of cyclooxygenase-2 selective inhibitor has not been rarely reported as a cause of erythema multiforme. Therefore, we report a case with a review of the literature.

Missed Fractures in Severely Injured Patients

PURPOSE: The purpose of this study is to analyze anatomic distributions, diagnostic methods, and prognosis of missed fractures in patients with severe injury. MATERIALS AND METHODS: A review of single-institutional medical records between January 2001 and May 2012 identified 58 patients with 62 delayed diagnoses of fractures among 4,643 severely injured patients older than 20 years with Injury Severity Scores higher than 16. We evaluated combined injuries, location of fractures, diagnostic methods, and reasons for missed diagnosis at initial exam. RESULTS: Among 62 missed fractures, there were eight cases of spine fracture, 10 cases of peri-shoulder joint fracture, eight cases of upper extremity fracture, 10 cases of pelvis of acetabulum fracture, and 26 cases of lower extremity fracture. Head injury was the most common concomitant injury (23 cases). Initially missed fractures were most commonly discovered by official reading by radiologists. The most common reasons for misdiagnosis were the use of improper radiologic study and missed-reading of proper radiologic studies. CONCLUSION: In order to prevent misdiagnosis of fractures in patients with severe injury, meticulous physical examination with suspicion of fractures should come first. In addition, obtaining proper radiologic study and thorough evaluation of radiologic images are important to decreasing the rates of missed fracture diagnoses. In addition, thorough surveillance for ipsilateral fractures is important in extremities with identified fractures.

Influence of Posterior Tibial Slope on Stability and Second-Look Arthroscopic Findings after Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze the influence of posterior tibial slope on stability in clinical and second-look arthroscopic evaluation after anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: From 2000 to 2011, 124 patients who underwent ACL reconstruction using an allogaft were enrolled in this study. A posterior tibial slope between 0degrees and 4degrees was found in 28 patients (group A), between 5degrees and 9degrees in 64 patients (group B), and greater than 10degrees in 32 patients (group C). We evaluated stability using the Lachman test and a KT-2000 arthrometer. In second-look arthroscopy, grafted tendons were evaluated based on the tension, rupture, and synovial coverage. RESULTS: In clinical evaluation for stability, mean KT-2000 arthrometer and Lachman test at last follow-up showed no statistically significant differences depending on posterior tibial slope. Second-look arthroscopic findings showed no statistically significant difference between groups A and B (p=0.91). However, statistically significant relations were observed between groups A and C (p=0.03), and between groups B and C (p=0.02). CONCLUSION: The results of this study suggest that patients who underwent ACL reconstruction with higher posterior tibial slope (> or =10degrees) have more lax tension in second-look arthroscopy, but not in clinical stability tests.

Reliability of Singh Index in Female Patients Older than 65 Years with Proximal Femoral Fracture / 대한골다공증학회지

OBJECTIVES: To evaluate osteoporosis in acute trauma situations, we compared reliability of Singh index values with bone mineral density in female patients older than 65 years with proximal femur fractures. MATERIALS AND METHODS: We enrolled 145 patients who treated between June 2006 and May 2011. The radiograph was done and assessed by 3 observers to determine Singh index values. The reliability of Singh index was expressed in terms of intraobserver and interobserver agreements using Fleiss's overall Kappa values, Pearson correlation coefficients, Kendall's Tau-b values. Correlation of bone mineral density and Singh index was measured using linear by linear association. RESULTS: Kappa values for intraobserver agreement ranged from 0.361 to 0.454. Kappa values for interobserver agreement ranged from 0.325 to 0.423 neither did not reach good reliability overall. There was no statistically significant correlation between Singh index and bone mineral density. CONCLUSIONS: Singh index is inappropriate method for clinic and research work due to poor interobserver agreement, though it is a simple and inexpensive method of assessing the osteoporosis in acute trauma patients.

Clinical Bilateral Poplitear Artery Entrapment Syndrome Caused by a Anomalous Origin of the Gastrocnemius Muscle / 대한스포츠의학회지

Popliteal artery entrapment syndrome can result from abnormal branching patterns of the popliteal artery or the anatomically abnormal placement of nearby muscles and tendons leading to a sustained compression of the popliteal artery. This compression leads to chronic capillary damage and early arteriosclerosis and embolism that can lead to distal ischemia. Thus early treatment is required to prevent harm to the lower limb. This is a rare congenital disease that mostly affects young adults, usually presenting with intermittent claudication of the leg, coldness and edema. A case where a 16-year-old female presented with pain and coldness in the lower right limb that started 1 year ago will be discussed. In this case, magnetic resonance imaging and arterial angiography lead to a diagnosis of popliteal artery entrapment resulting from an abnormal origin of the medial head of Gastrocnemius.

Treatment of Tibial Plateau Fractures Using a Locking Plate and Minimally Invasive Percutaneous Osteosynthesis Technique

PURPOSE: To acknowledge the importance of precise reduction of articular surface of tibial plateau fractures and to make a guideline of treatment by evaluating outcomes and effectiveness of using locking plate and minimally invasive percutaneous osteosynthesis technique. MATERIALS AND METHODS: Twenty-nine patients who underwent surgery for tibial plateau fracture from November 2005 to March 2010 were enrolled with 12 months follow-up in a retrograde manner. The Shatzker classification was used to classify fractures, and we used lateral submeniscal approach to make a precise reduction of articular surface. Radiologic evaluation was determined by presence of bone union, malalignment, and reduction loss or joint depression of articular surface. Post-operative infection, time of active movement of the knee joint, time of partial weight loading, and range of motion (ROM) of knee joint were evaluated. Lysholm Knee Score was used for functional evaluation. RESULTS: Bone union took place in all but one case that developed osteomyelitis. Angulation deformity of more than 10degrees and reduction loss or joint depression of more than 5 mm were not observed. There was one case of osteomyelitis and one case of superficial surgical site infection. There were satisfactory clinical results, with an average time of active knee joint movement and weight loading of 6 weeks. The average ROM of knee joint was 125degrees in the last follow up. As for functional evaluation using Lysholm Knee Score, cases showed an average Lysholm Knee Score of 94 which was a satisfactory result. CONCLUSION: In cases of tibial plateau fractures, if a surgeon accurately reduces the articular surface of joint and use minimally invasive locking plate it will help in bone union biologically, reducing the incidence of soft tissue injuries, and biomechanically maintaining the articular surface of the joint, proving itself to be a useful method of treatment.

Clinical Outcome of Surgical Treatment for Fracture of the Femoral Shaft with Ipsilateral Fracture of the Proximal Femur

PURPOSE: To analyze diagnostic process and clinical data in cases of fracture of the femoral shaft with fracture of the proximal femur. MATERIALS AND METHODS: We reviewed 24 cases of patient who undergone surgery for fracture of the femoral shaft with ipsilateral fracture of the proximal femur and more than 1 year of examination of follow up was available. Age, sex.location and classification of the fracture, the time of diagnosis and operation, the method of operation, the associated injuries, the time of bony union and complication were investigated, postoperative function was evaluated on Friedman and Wyman criteria. RESULTS: Bony union showed significant difference in the displacement and comminution of fracture, postoperative function revealed significant difference according to the associated injuries. The 6 cases (25%) out of 24 cases are failed early diagnosis, 4 cases out of 6 cases was detected during operation and 2cases was found after surgery. 21 cases out of 24 cases of femoral shaft fractures showed union, 23 cases out of 24 cases of femoral neck fractures showed union. There were eleven good, eleven fair, and two poor functional result according to Friedman and Wyman criteria. CONCLUSION: Precious clinical and radiologic examination is needed not to miss the diagnosis of proximal femur fractures in ipsilateral femoral shaft fractures with proximal femur fractures. Anatomical reduction and rigid fixation of proximal femur are important to reduce avascular necrosis of femoral head and nonunion of proximal femoral fractures.

Comparison of the Outcomes on Second-Look Arthroscopy after Anterior Cruciate Ligament Reconstruction Using a Hamstring Autograft or a Tibialis Anterior Allograft

PURPOSE: We wanted to evaluate the status and changes of the reconstructed anterior cruciate ligament (ACL) graft by performing second-look arthroscopy after arthroscopic reconstruction of the ACL with a hamstring autograft or a tibialis allograft. MATERIALS AND METHODS: From June 2003 to February 2007, second look arthroscopy was performed on 58 cases and a hamstring autograft was used in 36 cases and a tibialis allograft was used in 22 cases. Second-look arthroscopy was conducted at an average of 19.1 (12~42) months after reconstruction. We measured the graft tension using displacement by probing and the synovial coverage by visual analysis at the time of second-look arthroscopy. The Lysholm score, the Lachman test and a KT-2000 arthrometer were used to evaluate the status of the reconstructed ACL. RESULTS: The hamstring tendon autograft group showed normal tension in 25 cases, lax tension in 7 cases and partial tear in 4 cases. The tibialis anterior allograft group showed normal tension in 12 cases, lax tension in 5 cases and partial tear in 5 cases. In the hamstring tendon autograft group, the synovial coverage was good in 23 cases, there was half coverage in 8 cases and it was pale in 5 cases. In the tibialis anterior allograft group, the synovial coverage was good in 10 cases, there was half in 7 cases and it was pale in 5 cases. There were no significant differences between the two groups on the clinical examination, but on second look arthroscopy, the synovial coverage was better in the hamstring tendon autograft group than that for the tibialis anterior allograft group. CONCLUSION: The hamstring autograft group had superior synovial coverage compared to that of the other group on second look arthroscopy. But there were no significant difference of the clinical outcomes between the groups.

Effect of Traumatic Brain Injury on Healing of Femur shaft Fracture / 대한정형외과연구학회지

PURPOSE: Among the fracture patients, there is a tendency to form more callus and get fracture united earlier in groups with traumatic brain injury. This retrospective study is to evaluate the factors that might accelerate the bone formation by comparing two groups in serologic tests, clinical and radiologic results. MATERIALS AND METHODS: From March 2001 to July 2009, femur shaft fracture patients were divided in two groups 1) without traumatic brain injury (32cases), 2) fracture with traumatic brain injury combined (30cases). We evaluated the routine serologic exams, amount of callus formations during the follow up period. RESULTS: There was no statistical difference in WBC, CRP, total calcium, LDH level between two groups, except Alkaline phosphatase level. Amount of callus formation on AP radiograph at the last follow up period was 74.9% in study, 42.6% in control group. Lateral radiograph showed 73.2% of callus formation rate in study group and 32.0% in control group. CONCLUSION: Two groups had no significant difference with the routine serologic exam except Alkaline phosphatase. Group with traumatic brain injury had much more amount of callus formation but there was no evidence of traumatic brain injury accelerate the fracture healing.