Hyung Ku Yoon

Trigger thumb in children: results of surgical treatment in children above 5 years of age.

Background There have been debates about the results of surgical treatment in older children, even though many studies showed excellent results in pediatric trigger thumb. The objective of this study was to identify the possible problems or complications related to the delayed surgery for trigger thumb in children. Authors clinically reexamined the patients who had undergone A1 pulley release above the age of 5 years and analyzed the results of surgical treatment. Methods A retrospective study of 31 trigger thumbs was performed on 23 consecutive children treated using a standardized surgical technique. The mean age at the operation was 7.46 years and average period of clinical follow-up was 2 years and 3 months. We investigated the presence or absence of interphalangeal joint flexion contracture, triggering, recovery of active range of motion, postoperative period that the patients get more than 0 degree interphalangeal joint extension, and complications. Results Flexion contracture and painful triggering were successfully relieved after surgery in all cases. Patients showed variable periods in improving temporary extension weakness of interphalangeal joint, but there was no statistical difference in the final result between early and delayed improvement or between symptom duration and healing time. None of these patients had any postoperative complications. Conclusions Surgical treatment with A1 pulley release for over 5 years of age resulted in successful resolution of trigger thumb and satisfactory clinical outcome in all our cases regardless the age at the time of surgery. From the authors findings, we can expect satisfactory results of surgical treatment in pediatric trigger thumb even in the case of delayed diagnosis or late treatment.

Patterns of isotope uptake in sequential postoperative bone scan in undisplaced femoral-neck fractures

PurposeWe aimed to investigate the changing pattern of isotope uptake in the sequential bone scan test for the prediction of osteonecrosis of the femoral head in patients with an undisplaced femoral-neck fracture.MethodsFifty-four cases of sequential bone scan for nondisplaced femoral-neck fracture treated by internal fixation with cannulated screws between 2000 and 2009 were retrospectively studied. The mean follow-up period was 4.2xa0years. The first postoperative bone scan was performed twoxa0weeks postoperatively in all patients. Second, third, and fourth follow-up bone scans were performed at one to sixxa0months, 12–18 months, and 18–24xa0months postoperatively.ResultsMean femoral-head ratio (FHR) in the first postoperative bone scan was 0.99. Although it was under 1.0 in 38 patients (70.4xa0% of the 54 patients), only one patient developed osteonecrosis of the femoral head. The others showed hot uptake in their second follow-up bone scan. Mean FHRs in the second, third, and fourth postoperative bone scans were 1.69, 1.29, and 1.05, respectively, and there were significant statistical differences in each follow-up period (Pu2009=u20090.035). In addition, there were unique patterns of isotope uptake with the passage of time, such as cold uptake in the early stage, hot uptake in a couple of months, and iso-uptake in the late stage.ConclusionsEarly postoperative bone scan results should not be over interpreted when predicting osteonecrosis of the femoral head.

Comparison of Influence on Displaced Femoral Neck Fractures in Young Adults - Fracture Level and Comminution, Time to Operation and Reduction

Purpose : To analyze the influences of fracture level and comminution, time to operation and reduction quality on the results of displaced femoral neck fractures in young adults. Materials and Methods: From January 1996 to January 2003, 39 of 51 cases of displaced femoral neck fractures that were treated with closed reduction and percutaneous internal fixation using cannulated screws, were evaluated after at least two years of follow-up with respect to the fracture level, comminution, time to operation, and reduction quality. Results : The incidence of AVN and non-union were 6/39 (15.4%) and 3/39 (7.7%), respectively. The differences in the incidences of complications among subcapital, transcapital, and subcapital fractures was not significant (p=1 & p=1). There was a higher incidence of AVN (p=0.0066) and non-union (p=0.0219) with posterior comminutions than anterior ones. The time to operation was not an important factor in influencing the development of complications (p=0.4984 & p=1). Between acceptable and poor reductions, the differences in the incidences of AVN was significant (p=0.0105), but not in the incidences of non-unions (p=0.1011). Conclusion : We concluded that good quality of reduction is more important than the time to operation for achieving good results, and that comminution is a more important prognostic factor than is the fracture level.