ABSTRACT
PURPOSE: There are numerous opinions about the methods and usefulness of minimizing leg length discrepancies after hip arthroplasty. In this study, we tried to evaluate the usefulness of an intraoperative x-ray in addition to preoperative templating for minimizing leg length discrepancy. MATERIALS AND METHODS: We reviewed pre- and post-operative pelvis AP x-rays of 46 patients who underwent hip arthroplasty due to a traumatic femoral neck fracture or intertrochanteric fracture between May 2008 and February 2009. A leg length discrepancy is the difference in vertical distance between a horizontal line drawn along the bottom of the ischial tuberosities and the most inferior points of the lesser trochanter. It was measured in a pelvis AP x-ray. In each case, pre-operative templating was performed and an intraoperative pelvis AP x-ray was taken again to assess the accuracy of preoperative planning. Implant positions were readjusted when necessary. RESULTS: The mean post-operative leg-length discrepancy was 0.3 mm (SD, 3.1 mm). The range was from -5.8 mm to +5.9 mm. CONCLUSION: Combining preoperative templating and intraoperative x-rays is a useful method of minimizing leg length discrepancy during hip arthroplasty.
Subject(s)
Humans , Arthroplasty , Femoral Neck Fractures , Femur , Hip , Leg , PelvisABSTRACT
Multiple drilling of the femoral head is a commonly-used surgical technique for the treatment of osteonecrosis. Several holes are drilled into the femoral head using a small-diameter Steinmann pin. This decompression technique promotes revascularization and regeneration of necrotic tissue in the femoral head. Known complications are heterotopic ossification and femoral subtrochanteric fractures, although these have only been rarely reported. Our case study focuses on a subtrochanteric fracture 6 weeks after a multiple drilling operation.
Subject(s)
Decompression , Femur , Head , Hip Fractures , Mandrillus , Ossification, Heterotopic , Osteonecrosis , RegenerationABSTRACT
Spinal perineural cyst rarely appears in the upper lumbar spinal region as compared it occurrence at other spinal region. These cysts seldom cause radiating pain and neurologic symptoms because the majority of these cysts involve the sacral portion of the spine. Spinal perineural cyst can be recognized incidentally on magnetic resonance imaging while differentiating other diseases that cause back pain. The differential diagnosis of symptoms is needed to rule out whether or not the intraspinal cystic mass is the actual cause of radiculopathy. We report here on a case of perineural cyst at a left neural foramen of L2-3 and the patient displayed neurologic manifestations. The patient had progressively aggravated low back pain and sciatica of two years duration. MRI well demonstrated neural compression of the left 2nd lumbar neural root. Relief of symptoms were achieved by performing posterior decompression (hemilaminectomy, fascectomy & decompression of the ligamentum flavum), excision of the cyst and posterolateral fusion of L2-3.
Subject(s)
Humans , Back Pain , Decompression , Diagnosis, Differential , Low Back Pain , Magnetic Resonance Imaging , Neurologic Manifestations , Radiculopathy , Sciatica , Spine , Tarlov CystsABSTRACT
PURPOSE: This study was performed to evaluate the risk factors affecting the failure of fixation and to analyze the clinical and radiologic results after operation with using a sliding hip screw for treating OTA type A2 intertrochanteric fractures of the femur. MATERIALS AND METHODS: From January 2001 to June 2005, we reviewed the clinical records and the serial radiographs of 53 patients (OTA type A2 intertrochanteric fractures of the femur) who were treated with a 135-degree angled sliding hip screw. We analyzed the change in the neck-shaft angle, the sliding distance and failure of the sliding screw, according to the reduction of the lesser trochanteric fragment and the stability of the lateral buttress. RESULTS: Among 53 patients, there were 15 cases (28.3%) of failures to reduce the lesser trochanteric fragment. Losses of the lateral buttress were observed in 35 cases (66.0%). There were 8 cases (15.1%, 8/15) that failed radiologically, including cutting out of the sliding hip screw from a femoral head (3 cases), metal failure (1 case) and excessive sliding (4 cases). There were significantly differences for the changes of the angle of the neck-shaft, the distance of sliding and the length of penetration of the sliding hip screw, according to the reduction of the lesser trochanteric fragment and the stability of the lateral buttress. CONCLUSION: It is important to consider the reduction of the lesser trochanteric fragment and the stability of lateral buttress when treating OTA type A2 intertrochanteric fractures with using a sliding hip screw.
Subject(s)
Humans , Femur , Head , Hip Fractures , Hip , Risk FactorsABSTRACT
Ganglion cyst and synovial cyst are rarely found in the lumbar spinal canal. Synovial cysts usually arise from degenerative apophyseal joints, and ganglion cysts arise from articular facet joints. We present here two cases: one ganglion cyst that arose from the posterior longitudinal ligament at the L2-3 intervertebral space level, and a synovial cyst that also arose from the posterior longitudinal ligament at the level of the L4 body. Both patients progressively developed low back pain with radiating pain. The lesions were detected by magnetic resonance imaging in both cases. The dural sac was displaced by the cysts in both cases. Relief of symptoms was achieved by decompressive laminectomy and excision of the ganglion cyst, and excision of the synovial cyst and PLIF at L3-4. Because these lesions have not been reported on before, we report here on 2 cases with synovial and ganglion cyst from the posterior longitudinal ligament at lumbar spinal level.
Subject(s)
Humans , Ganglion Cysts , Joints , Laminectomy , Longitudinal Ligaments , Low Back Pain , Magnetic Resonance Imaging , Spinal Canal , Synovial Cyst , Zygapophyseal JointABSTRACT
PURPOSE: We made a radiological comparison between 60 degrees distal Chevron osteotomy with short armed two parts and 40 degrees distal Chevron osteotomy with long armed one part performing operation in cases of hallux valgus angle of less than 40 degrees, intermetatarsal angle of less than 15 degrees. MATERIALS AND METHODS: 12 cases with 60 degrees distal Chevron osteotomy and 12 cases with 40 degrees distal Chevron osteotomy were selected from October 2000 to March 2005. We have analysed the hallux valgus angle, 1-2 intermetatarsal angle, metatarsal length, distal metartarsal articular angle and angulation at osteotomy site on lateral view in each radiological films taken at preoperative, postoperative and 3 months after operation presuming bone union. All cases were women, both sides were 9 cases and average age was 52.3 years old. RESULTS: Data taken at preoperative, postoperative and 3 months follow up films in 60 degrees distal Chevron osteotomy were as follows; the hallux valgus angles were 32.1 degrees, 10.9 degrees, 13.8 degrees, the 1-2 intermetatarsal angles were 13.6 degrees, 8.5 degrees, 8.4 degrees, the metatarsal length were 60.6 mm, 58.8 mm, 58 mm, the distal metartarsal articular angles were 13 degrees, 6 degrees, 6.6 degrees and 3 cases were over 3 degrees angulation at lateral view. In 40 degrees distal Chevron osteotomy, the hallux valgus angles were 34.5 degrees, 11.6 degrees, 15.3 degrees, the 1-2 intermetatarsal angles were 12.7 degrees, 8.2 degrees, 7.8 degrees, the metatarsal length were 59.2 mm, 56.9 mm, 55.9 mm, the distal metartarsal articular angles were 12 degrees, 7.3 degrees, 7.3 degrees and there were no case with angulation over 3 degrees at lateral view. CONCLUSION: In comparison between 60 degrees distal Chevron osteotomy and 40 degrees distal Chevron osteotomy measuring at postoperative and follow up, most of all data were similar, but 3 cases over 3 degrees angulation at lateral view happened in 60 degrees Chevron osteotomy. This result showed that 40 degrees distal Chevron osteotomy fixing with screws through long armed one part may have benefit than 60 degrees distal Chevron osteotomy fixing with K-wires through short armed two parts in making rigid fixation, even though there is a personal difference of technigue.
Subject(s)
Female , Humans , Arm , Follow-Up Studies , Hallux Valgus , Hallux , Metatarsal Bones , OsteotomyABSTRACT
PURPOSE: We made a radiological comparison between 60 degrees distal Chevron osteotomy with short armed two parts and 40 degrees distal Chevron osteotomy with long armed one part performing operation in cases of hallux valgus angle of less than 40 degrees, intermetatarsal angle of less than 15 degrees. MATERIALS AND METHODS: 12 cases with 60 degrees distal Chevron osteotomy and 12 cases with 40 degrees distal Chevron osteotomy were selected from October 2000 to March 2005. We have analysed the hallux valgus angle, 1-2 intermetatarsal angle, metatarsal length, distal metartarsal articular angle and angulation at osteotomy site on lateral view in each radiological films taken at preoperative, postoperative and 3 months after operation presuming bone union. All cases were women, both sides were 9 cases and average age was 52.3 years old. RESULTS: Data taken at preoperative, postoperative and 3 months follow up films in 60 degrees distal Chevron osteotomy were as follows; the hallux valgus angles were 32.1 degrees, 10.9 degrees, 13.8 degrees, the 1-2 intermetatarsal angles were 13.6 degrees, 8.5 degrees, 8.4 degrees, the metatarsal length were 60.6 mm, 58.8 mm, 58 mm, the distal metartarsal articular angles were 13 degrees, 6 degrees, 6.6 degrees and 3 cases were over 3 degrees angulation at lateral view. In 40 degrees distal Chevron osteotomy, the hallux valgus angles were 34.5 degrees, 11.6 degrees, 15.3 degrees, the 1-2 intermetatarsal angles were 12.7 degrees, 8.2 degrees, 7.8 degrees, the metatarsal length were 59.2 mm, 56.9 mm, 55.9 mm, the distal metartarsal articular angles were 12 degrees, 7.3 degrees, 7.3 degrees and there were no case with angulation over 3 degrees at lateral view. CONCLUSION: In comparison between 60 degrees distal Chevron osteotomy and 40 degrees distal Chevron osteotomy measuring at postoperative and follow up, most of all data were similar, but 3 cases over 3 degrees angulation at lateral view happened in 60 degrees Chevron osteotomy. This result showed that 40 degrees distal Chevron osteotomy fixing with screws through long armed one part may have benefit than 60 degrees distal Chevron osteotomy fixing with K-wires through short armed two parts in making rigid fixation, even though there is a personal difference of technigue.
Subject(s)
Female , Humans , Arm , Follow-Up Studies , Hallux Valgus , Hallux , Metatarsal Bones , OsteotomyABSTRACT
PURPOSE: To evaluate the methods and results of the surgical treatment in the trimalleolar fracture of the ankle. MATERIALS AND METHODS: We analysed the results of the ankle trimalleolar fracture which were treated with open reduction and internal fixation from January 1999 till September 2003. There were 45 patients who had at least six months follow up, 16 men, and 29 women. We have analysed the mechanism of injury, methods of operation and postoperative complications. RESULTS: The results were assessed on ankle AP, lateral and mortise X-rays and retrospective chart review. There were 30 supination-external rotation, 13 pronation-external rotation, 2 pronation-abduction in the mechanism of injury by Lauge-Hansen classification. Cases of the posterior malleolar fracture which involved more than 25% of the weight bearing surface were 7 (15.6%). Medial malleolar mono-fixation was done in 5 cases, fibular mono-fixation in 2 cases, bimalleolar fixation in 32 cases, trimalleolar fixation in 6 cases. 38 cases (84.4%) were good or excellent in clincal assessment and 39 cases (86.7%) were good or excellent in radiological assessment according to the criteria of the Meyer. There was no difference of results among the surgical treatment methods. CONCLUSION: The results of our study indicate that the rigid fixation with early ankle motion and weight bearing is needed in ankle trimalleolar fracture. But minimal fixation is not bad in slight displaced fracture. Both anterior approach and posterior approach were useful methods to stabilization the posterior malleolar fracture. And pre-operative evaluation to detect the hidden soft tissue injuries and fracture mechanism is very important to avoid the failure.
Subject(s)
Female , Humans , Male , Ankle , Ankle Fractures , Classification , Follow-Up Studies , Postoperative Complications , Retrospective Studies , Soft Tissue Injuries , Weight-BearingABSTRACT
PURPOSE: We evaluated the clinical results of operative treatment of the intraarticular calcaneal fracture according to fracture classification. MATERIALS AND METHODS: There were 25 cases (24 patients) which had at least one year follow up, 17 men and 7 women who were treated from June 1997 to March 2003. We have analysed the Bohler's angle, cruciate angle, width and posttraumatic osteoarthritis in radiological evaluation, and evaluated clinical results according to the Creighton-Nebraska health foundation score. RESULTS: Excellent results were noted in 7 cases, good results in 6 cases, fair results in 4 cases and poor results in 8 cases. Radiological changes showed as follows: Bohler angle 17 degrees, Crucial angle 0.1 degrees, Width 6mm. CONCLUSION: Type II showed satisfactory results and type IV showed unsatisfactory results in Sanders classification. Proper evaluation of the intraarticular calcaneal fracture by X-ray and CT scan is necessory to predict prognosis and decise method of operative treatment.
Subject(s)
Female , Humans , Male , Calcaneus , Classification , Follow-Up Studies , Intra-Articular Fractures , Osteoarthritis , Prognosis , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To review the results of resections of heterotopic ossification around the hip in patients with central nervous system injuries. MATERIALS AND METHODS: Heterotopic ossification was resected in ten hips of eight patients and followed for at least one year. Average age was 38.1 years (range, 21-56 years). We reviewed the charts and the radiographs for overall patient function, location of the lesion, radiographic evidence of maturation and any recurrence. Heterotopic ossification was resected regardless of the result of bone scan. RESULTS: All patients showed improved function. Three minimal recurrences and one moderate recurrence were identified at the last follow-up radiography, but the range of motion had not decreased due to recurrence. CONCLUSION: Severe heterotopic ossification around the hip in patients with spastic paralysis was resected, and it was found that the range of motion was improved in all patients and that the chance of recurrence was minimal, even though the bone scan showed hot uptake on the bone scan.
Subject(s)
Adult , Humans , Central Nervous System , Follow-Up Studies , Hip Joint , Hip , Muscle Spasticity , Ossification, Heterotopic , Paralysis , Radiography , Range of Motion, Articular , RecurrenceABSTRACT
PURPOSE: To investigate the influence of sensory impairment and vascular insufficiency on the development and treatment of diabetic foot lesions. MATERIALS AND METHODS: From July 1995 to June 1997, 25 subjects with diabetic foot lesions were treated with an average follow-up of 19.6 months (range, 12-35 months). Sensory evaluation was performed with the Semmes-Weinstein monofilaments and a 256 cycles-per-second tuning fork, Vascular testing was performed with IMEXLAB 9,000 workstation in 24 of 25 subjects. RESULTS: In 22 of 25 patients, they could not perceive 5.07 monofilament and also could not feel vibration. In 6 patients, the vascular flow was normal, and there were mild insufficiency in 10 patients and severe insufficiency in 8 patients. The degree of vascular insufficiency correlated with the severity of the lesion (Wagner classification) and also with the result of the treatment. Despite severe vascular insufficiencies, foot lesions could be treated by forefoot amputations in 7 of 8 patients. Overall there were 9 recurrences after initial healing. CONCLUSIONS: This study shows that it is essential to educate patients on taking care of their foot because most of them do not have protective sensation. Vascular insufficiency may be related to the severity of the lesions and the result of treatment. We have to pay continuous attention to these patients for early detection of recurrence after initial treatment of the foot lesions.
Subject(s)
Humans , Amputation, Surgical , Diabetic Foot , Follow-Up Studies , Foot , Ischemia , Recurrence , Sensation , VibrationABSTRACT
Since CT scanning was introduced in the diagnosis of calcaneal fracture, we became to understand more clearly the pathoanatomy of the injury. However we have to determine if we would or would not take CT scanning by simple radiography in the acute setting and most of the surgeons still use simple radiography in evaluating postoperative result. And also we have to determine the accuracy of reduction and position of screws by simple radiography intraoperatively. The purpose of this report is to determine the accuracy of simple radiography in assessing the pathological anatomy of the intraarticular calcaneal fracture by experimental and clinical studies. This is a combined experimental and clinical studies using four below knee amputation specimens and 15 patients with 19 displaced intraarticular calcaneal fractures treated at Hanil General Hospital between Jan. 1996 and May 1997. The lateral view of the foot was the best radiographic view for visualizing the degree of depression of the posterior facet. With regard to the location of a fracture line, findings of Broden views correlated well with findings on CT in 17 of 19 fractures. With regard to gapping between fragments, the axial view was not satisfactory in the majority of cases(15 of 19 cases). There was no case which showed more than 2 mm of discrepancy between the findings on Broden view and CT. We conclude that we may obtain most of the important informations about the pathological anatomy of the intraarticular calcaneal fracture by simple radiography.
Subject(s)
Humans , Amputation, Surgical , Depression , Diagnosis , Foot , Hospitals, General , Knee , Radiography , Tomography, X-Ray ComputedABSTRACT
The percutaneous pinning is a simple, effective method for the treatment of displaced supracondylar fractures of the humerus in children. But there is some controversy in the number of pins used and the method of pin insertion. The cross pinning method provides more stability at the fracture site but the risk of ulnar nerve damage is higher than in lateral pinning method, The senenty-one displaced extension type supracondylar fractures were treated by closed reduction and percutaneous cross pinning from January 1991 to October 1994. Among them, the medial pin was inserted in elbow extension in twenty-eight cases and in forty- three cases the medial pin was inserted in elbow flexion. Ulnar nerve injury occured postoperatively in six cases, in which the pin was inserted with the elbow in flexion position. These results may suggest that when percutaneous cross pinning method is selected to fix the supracondylar fracture of the humerus, it would be safer to insert one or two lateral pins with the elbow in full flexion position followed by one medial pin in extension position in order to reduce the risk of loss of reduction and ulnar nerve damage.
Subject(s)
Child , Humans , Elbow , Humerus , Methods , Ulnar NerveABSTRACT
We present a case of medial malleolus and deltoid ligament loss with extensive overlying soft tissue defect from crushing injury. The resultant gross medial ankle instability necessitated deltoid ligament reconstruction using a bone-patellar tendon graft.
Subject(s)
Child , Humans , Ankle , Ligaments , Patella , Patellar Ligament , Tendons , TransplantsABSTRACT
There are many methods in reconstruction for skin defect in hand and forearm. Among them, reverse ulnar artery forearm flap has several advantages which are versatile, safe and convenient flap. We report 6 cases of our experiences.
Subject(s)
Forearm Injuries , Forearm , Hand , Skin , Ulnar ArteryABSTRACT
The electrical burns constitute a unique type of thermal injury and usually consist of a limited area of cutaneous burn, but associated with deep muscle damage of variable extent. The deep tissue destruction resulting from such injury leads to high incidence of amputation. So electrical burns are different from other types of injuries requiring individualized and varied methods of treatment, such as early fasciotomy, repeated debridement, wound coverage and technique of amputation. During 5 years from Jan. 1988 to Dec. 1992, we experienced 310 cases of electrical burn. We analyzed these cases on the aspects of functional result and necessity of amputation according to the treatment variability. The result showed the extent of burn in amputation group was 11.6%, salvage group 13.1%, with no difference of extent between 2 groups(p>0.05, by qui square test). When the fasciotomy was done earlier than 12 hours after injury showed 39.1% of more than good functional result, when later than 12 hours 7.7% of more than good, that is, earlier fasciotomy resulted in better function(p < 0.05, qui square test). The amputation rate was 23.9% during the last 5 years which was a marked improvment when compared to the previous ten years(32.4%). From these results we concluded that in order to reduce the rate of amputation and to improve the function of patients, early fasciotomy, early repeated debridement and wound coverage is necessary.