Joo Chul Ihn

Femoral lengthening over an intramedullary nail using the external fixator Risk of infection and knee problems in 22 patients with a follow-up of 2 years or more

Background The time for femoral lengthening is shortened if external fixation is combined with intramedullary nailing. However, several complications have been reported with this procedure. Patients and methods We retrospectively reviewed the outcome of femoral lengthening performed over an intramedullary nail using external fixation in 22 patients. These patients were followed for a mean of 3.2 (2-5.2) years. The mean age was 22 (13-35) years at the time of the index procedure. The mean lengthening was 5 (2.7-8.1) cm and the external fixator was removed after median 20 (8-30) weeks. The mean external fixation index was 24 (11-35) days/cm and the mean consolidation index was 43 (26-55) days/cm of lengthening. Results 3 patients who had a past history of infection or open trauma developed osteomyelitis which required removal of the nail. There were 4 knee joint complications when the lengthening was over 20%, including posterior knee subluxation and patella subluxation. In 1 patient, the lengthened segment collapsed with breakage of locking screws. Interpretation Although lengthening over a nail can reduce the duration of external fixation, caution is required to prevent major complications.

The treatment of double disruption of the superior shoulder suspensory complex

Abstract. Between January 1997 and March 2000, we treated 13 patients with double disruption of the superior shoulder suspensory complex (SSSC). The mean age of the patients was 42 (20–63) years. All patients had associated chest injuries, but there were no injuries of the brachial plexus or the peripheral nerves. Three patients, whose general condition was poor, were treated conservatively. Five underwent internal fixation of both the clavicular and scapular fractures and five of the clavicle only. We evaluated the clinical results using the Rowe Score after a minimum follow-up of 1 year. All fractures united. The average time to union was 14 weeks for clavicular and 11 for scapular fractures. There was malunion in four of five scapular fractures treated conservatively. A functionally better result was obtained in the surgical group with a mean Rowe Score of 88, compared with the conservative group whose mean score was 77. Surgical treatment for double disruption of the SSSC is a good option, allowing early rehabilitation and giving good functional results.Résumé. Entre janvier 1997 et mars 2000, nous avons traité 13 malades avec une double interruption de la ceinture scapulaire. Lâge moyen des malades était de 42 (20–63) ans. Tous les malades avaient des atteintes concomitantes de la cage thoracique. Aucune lésion du plexuxa0s brachial ou des nerfs périphériques na été observée. Trois malades ont eu un traitement conservateur en raison de leur état général. Cinq malades ont eu une fixation interne des fractures claviculaires et scapulaires, et cinq nont eu quune fixation de la fracture claviculaire. Après un suivi minimum dune année nous avons évalué les résultats cliniques en utilisent le score de Rowe. Toutes les fractures ont consolidé dans un temps moyen de quatorze semaines pour les fractures claviculaires et onze semaines pour les fractures scapulaires. Pour cinq fractures scapulaires traitées sans fixation interne, il y avait quatre cals vicieux. Daprès le score de Rowe un résultat fonctionnellement meilleur a été rapporté dans le groupe chirurgical (88) plutôt que dans le groupe conservateur (77). Le traitement chirurgical de la double du complexe suspenseur supérieur de lépaule est une bonne option pour obtenir des résultats fonctionnellement bons.

Bone transport over an intramedullary nail for reconstruction of long bone defects in tibia

BackgroundAlthough long bone defects may be treated by callus distraction, frequent complications arise from the long duration of external fixation. To reduce such complications, bone transport over an intramedullary nail (BTON) has been done for tibial bone defect.MethodsIn 12 patients (mean age, 46.1xa0years) of chronic osteomyelitis or bone defect, segmental transport was done using external fixator over an intramedullary nail. Prior to the index procedure, all patients had had serial debridements and five required myocutaneous or free flaps for covering of soft tissue defects. Using Mekhail’s criteria, functional results were evaluated.ResultsThe mean transported amount was 5.9 (range, 3.5–12)xa0cm. The mean external fixation index was 26xa0days/cm, and healing index was 62.6xa0days/cm. The primary union of distraction and docking site was achieved in all, except for one failure in union at the docking site, which required another bone graft. Except for one patient with associated ankle injury, all had excellent or good functions. There was one recurrence of osteomyelitis and one procurvatum of the proximal tibia of 10°.ConclusionBTON may be a successful method in tibial reconstruction and allows patients to return to daily life earlier with relatively few complications.

Negative pressure wound therapy for soft tissue injuries around the foot and ankle

BackgroundThis study was performed to evaluate the results of negative pressure wound therapy (NPWT) in patients with open wounds in the foot and ankle region.Materials and methodsUsing a NPWT device, 16 patients were prospectively treated for soft tissue injuries around the foot and ankle. Mean patient age was 32.8 years (range, 3–67 years). All patients had suffered an acute trauma, due to a traffic accident, a fall, or a crush injury, and all had wounds with underlying tendon or bone exposure. Necrotic tissues were debrided before applying NPWT. Dressings were changed every 3 or 4 days and treatment was continued for 18.4 days on average (range, 11–29 days).ResultsExposed tendons and bone were successfully covered with healthy granulation tissue in all cases except one. The sizes of soft tissue defects reduced from 56.4 cm2 to 42.9 cm2 after NPWT (mean decrease of 24%). In 15 of the 16 cases, coverage with granulation tissue was achieved and followed by a skin graft. A free flap was needed to cover exposed bone and tendon in one case. No major complication occurred that was directly attributable to treatment. In terms of minor complications, two patients suffered scar contracture of grafted skin.ConclusionNPWT was found to facilitate the rapid formation of healthy granulation tissue on open wounds in the foot and ankle region, and thus, to shorten healing time and minimize secondary soft tissue defect coverage procedures.

Reconstruction of the Anterior Cruciate Ligament in over 40-year-old Patients

Purpose: The purpose of the current study was to examine outcome after ACL reconstruction in patients over 40 years old, and to evaluate factors affecting outcome, such as, associated injuries and the preoperative period after injury. Materials and Methods: Clinical results were obtained from 36 cases over 40 years old at the time of surgery. The average age was 45 years (40 to 67 years), and the average follow-up period was 27.6 months (12 to 85 months). Group 1 was composed of 13 cases with a less than 3 months preoperative period, and group 2 23 cases of more than 3 months. 31 cases had associated injuries and 5 cases did not. The parameters used were the Lachman test, KT-2000 arthrometry, Lysholm score, IKDC score, and return to sports activity before injury. Results: The Lachman test was positive in 9 cases (25%) and mean side-to-side difference as determined by KT-2000 arthrometry was 3.9mm, however, there was no statistical difference between group 1 and group 2, regardless of associated injuries (p>0.05). Lysholm score averaged 89.8 in total, and was 92.2 in group 1 and 88.5 in group 2, and 93.6 in those without associated injury and 89.2 in those with associated injury (p>0.05). The IKDC score was normal (A) in 7 cases, nearly normal (B) in 25, abnormal (C) in 4. Twelve cases (92.3%) were graded A or B in group 1, and 20 cases (87%) were graded A or B in group 2 (p>0.05). There were 5 cases (100%) of grade A or B in the group without associated injury and there were 27 cases (87.1%) of A or B in group with associated injury (p>0.05). Return to sports activity before injury was possible in 19 cases (53%); 7 cases (53.8%) in group 1 and 12 cases (52.2%) in group 2 (p>0.05), and 3 cases (60%) in the group without associated injury and 16 cases (51.6%) in the group with associated injury (p>0,05). Conclusion: In patients over 40 years old with ACL injury, results can be successful after ACL reconstruction.

Apoptosis of Cells of Interfacial Tissue of Aseptic Loosening and Osteolysis after Hip Arthroplasty

Purpose : To evaluate the relationships between the apoptosis induced by nitric oxide (NO), aseptic loosening and osteolysis, which are the most serious causes of failure after total hip arthroplasty. Materials and Methods : Apoptosis of the inflammatory cells of interface tissues from 18 patients who underwent revision hip arthroplasty was identified by Terminal Deoxyribonucleotidyl Transferase-Mediated dUTP Nick End Labeling (TUNEL). The reaction to immunostaining of inducible nitric oxide synthase (iNOS), p53, Bax, Bcl2, and Ki-67 were evaluated. Six joint capsules obtained from six patients of femoral neck fracture were studied as controls. Results : Sixteen (89%) of 18 interface tissues were positive for iNOS, p53, and Bax monoclonal antibody and twelve (40%) for Bcl2 and Ki-67 monoclonal antibody. All tissues were positive for TUNEL. In the control group of six joint capsules, only one (17%) was positive for iNOS and Bax, and three (50%) were positive for TUNEL. The incidences of apoptotic signals at the interfacial tissue of aseptic loosening and osteolysis were significantly greater than those of the control. Conclusion : The current study suggested that the apoptosis of inflammatory cells, due to oxidative stress by NO, might be involved in the development of implant loosening and osteolysis after total hip arthroplasty. This information might be crucial for the treatment and prevention of periprosthetic osteolysis and subsequent loosening.

Effect of Orthovanadate on Collagen and Fibronectin Synthesis, and Alkaline Phosphatase Activity in MC3E3-E1 Osteoblast cells

Purpose : The purpose:of this study was to know the effect of inhibition of protein dephosphorylation on the synthesis of collagen and fibronectin (FN), alkaline phosphatase (ALP) activity, and the formation of bone nodule in MC3T3-E1 osteoblasts using orthovanadate (OVA) which is a potent protein tyrosine phosphatase (PTPases) inhibitor. Materilas and Methods : The synthesis of collagen, noncollagenous protein (NCP), and percent collagen in MC3T3-E1osteoblasts with or without OVA treatment according to concentration and time sequence was determined by incorporation of []-proline, synthesis of FN by [] methionine incorproated immunoprecipitation after treatment with 100 OVA for 24 hours, mRNA expression of collagen and FN by Northern blotting, activity of ALP by spectrophotometric method, and formation of bone nodule by staining method. Results : OVA increased collagen and NCP synthesis concentration dependently, until 12 hours in short-time culture, and time dependently through the differentiation until 29 days, however, there was no significant effect on the percent collagen production. OVA increased percent collagen synthesis significantly at 6 hours, and decreased in a long time culture. Total FN synthesis and FN synthesis in cell layer were increased by OVA, however, FN synthesis in medium was not changed. OVA decreased collagen mRNA level dose-dependently and increased the steady-state level of FN mRNA. OVA inhibited activity of ALP in both short and long-time culture. OVA inhibited bone nodule formation in MC3T3-E1 osteoblasts. Conclusion : These results indicate that the inhibition of PTPase by OVA increased the synthesis of collagen, FN, and decreased ALP activity and it resulted in the inhibition of bone formation in MC3T3-E1 osteoblast cells.

Long-Term Results of Total Hip Arthroplasty using a Cemented M

Purpose : The purpose of this study was to evaluate the long-term results of cemented Muller prostheses using a 32 mm metal femoral head. Materials and Methods : We reviewed 43 (31 patients) of 76 (55 patients) consecutive THAs, which were performed between April 1978 and September 1985. The average duration of follow-up was 148 months (range, 65-279 months). The average age at the time of index operation was 44.4 years. Preoperative diagnosis was osteonecrosis in 31 hips, posttraumatic osteonecrosis in 8 hips, osteoarthritis in 2 hips, and rheumatoid arthritis in 2 hips. We assessed cases clinically by Harris hip scores and radiographically by loosening and osteolysis, and measured polyethylene wear by the Livermore method. Kaplan-Meier analysis was used to evaluate survivability. We analyzed the relationship and the statistical difference between wear and age, weight, height, body mass index, diagnosis, polyethylene thickness, and cup inclination (Pearson correlations analysis, Student t-test, ANOVA test). The p-value was set p/yr respectively, and a 10-year cumulative survival rate was 72% (67-80%, 95% confidence interval). Revision surgery was performed in 27 hips (63%) and the mean time from index operation to revision was 129 months. The linear and volumetric wear rates increase significantly as body mass index increased (p or > ) (p