Jong-Hyuk Park

Plasma spray-coated Ti femoral component for cementless total hip arthroplasty

A retrospective study of the clinical and radiographic results of Mallory Head total hip arthroplasties in 67 patients (76 hips) with a mean age of 50.1 years was undertaken. The mean follow-up period was 10.1 years (9-13years). In this study, excellent or good clinical results were found for 64 patients. Minimal thigh pain was found in 3 patients (4.4%). Seventy-one hips (93.4%) showed fixation by bony ingrowth and 3 (3.9%) showed stable fibrous fixation. Bony ongrowth and ingrowth were also seen in 16 hips (21%) at distal smooth and grit-blast areas. Two femoral components were revised (survival rate, 97.3%), one for subsidence and other for recurrent infection. We believe that these good results were caused by excellent bony ingrowth on the proximal two thirds of the femoral surface area. In conclusion, proximal plasma-spray coating and the tapered shape of the Ti stem showed excellent bony ingrowth and initial stability. Our results indicate that the tapered shape will be an important element in the design of a cementless Ti stem.

A Distal Fluted, Proximal Modular Femoral Prosthesis in Revision Hip Arthroplasty

Most reports on the use of modular femoral stems during revision surgery have involved short follow-up periods. The authors evaluated the clinical and radiographic performance of 59 patients fitted with a distal fix modular stem. The average follow-up period was 8.2 years. Average Harris hip score was improved from 47 to 87.6. Of 19 patients with trochanteric osteotomy, 4 had a displaced greater trochanter. Re-revision was performed in 5 patients, and 3 of these were for subsidence (of these 3, subsidence was associated with dissociation of the coupling part in 1 and with osteotomy nonunion in other 2 [proximal component only]). Modular distally fixed femoral stems were found to offer intraoperative flexibility, but to suffer from subsidence and intraoperative greater trochanter and metaphyseal femoral fractures.

The management of the displaced medial wall in complex acetabular fractures using plates and additional cerclage.

Reduction for displaced quadrilateral plates in complicated acetabular fractures is difficult and requires wide exposure. The purpose of this study is to assess the usefulness of the additional cable in this complicated fracture and to evaluate the potential danger of compressing the superior gluteal artery and nerve with cable application. We evaluated 31 hips (these included 25 hips with fractures of both columns, two posterior wall and column fractures, three anterior column and posterior hemitransverse fractures, and one high T-shaped fracture) with an average six-year follow-up. Clinical outcomes were evaluated using a modification of the Matta grading system and radiographic arthritic grades. We assessed the postoperative clinical outcomes in relation with other variables such as anatomical reduction, delayed operation, seagull sign, and femoral head injuries. We determined whether the superior gluteal artery and nerve were compressed by cerclage with the help of femoral angiography and EMG. Clinical outcomes were graded as very good to excellent for 18 patients, good for five, fair for three and poor for five. Pre-Operative femoral head injury (P = 0.011), a seagull sign (P = 0.001), poor reduction (P = 0.015), and delayed reduction (P = 0.05) were found to statistically influence clinical results. We found that there were no injuries to the superior gluteal artery and nerve in spite of using a cable. Cerclage methods can be useful for initial reduction of displaced medial plates in acetabular fractures. These methods reduce operation time and blood loss as compared with other methods.

Ureteral Penetration Caused by Drilling During Internal Pelvic Bone Fixation: Delayed Recognition

A 49-year-old man was referred to our department with profuse serous fluid discharge from a Penrose drain after undergoing internal fixation with metal screws for multiple pelvic bone fractures. A definite ureteral penetration was identified that was orientated from the lateral to the medial aspect of the right distal ureter. The patient was surgically treated with excision of the 2-cm injured ureteral segment, end-to-end ureteroureterostomy, and double J ureteral stent placement. To our knowledge, a penetrating ureteral injury caused by bone drilling has not been reported previously in the published literature. This case shows that surgeons who do pelvic surgery, including orthopedic surgeons, should be familiar with the anatomical relationship of the ureter and its potential injuries.

Use of tissue expansion to allow reconstruction of the back after wide resection of a diffuse neurofibroma

Abstract Diffuse neurofibroma presents as a diffuse overgrowth of subcutaneous tissue, and usually involves the face, scalp, neck, or chest, but rarely occurs in the back. The management of large soft tissue defects after wide resection of a diffuse neurofibroma is a major surgical challenge. We report the case of a diffuse neurofibroma of the back that required reconstruction after wide resection of the tumour using an expanded myocutaneous advancement flap and a tissue expander. Tissue expansion is essentially a simple technique for expanding available normal skin, and it provides optimally matched skin in terms of colour, texture, hair-bearing qualities, and sensation.