Kwon Ick Ha

Stress Fractures of the Ribs in Golfers

During a collaborative review at three institutions, we documented 19 cases of stress fractures of the ribs in golfers. There were 13 men and 6 women with an average age of 39 years (range, 29 to 51). The 4th to 6th ribs were the most commonly injured. All fractures occurred along the posterolateral aspect of the ribs, and nine patients had fractures in more than one rib. Sixteen golfers sustained injury on the leading arm side of the trunk. Eighteen golfers were beginners, and the one experienced golfer had dramatically increased his practice time on the driving range before injury. Plain radiographs were usually diagnostic. However, bone scintigraphy was necessary to reach a diagnosis in three cases. A delay in diagnosis of 6 to 8 months occurred in two cases that were originally misdiag nosed as back strains. Stress fractures of the ribs in golfers may be more common than previously realized and may be incorrectly diagnosed as recalcitrant back strains. Based on the findings of other studies, we think fatigue of the serratus anterior is the mechanism of injury. We recommend strengthening the serratus an terior as rehabilitation after this injury and in a general conditioning program for golfers.

A clinical study of the natural remodeling of burst fractures of the lumbar spine.

Surgical decompression and fixation are considered by many to be the preferred treatment for burst fractures of the lumbar spine, regardless of neurologic deficit. For 6 patients with burst fracture of the lumbar spine but without neurologic deficit, computed tomography scans revealed >50% encroachment of the spinal canal. All 6 patients were treated conservatively, and during the followup period (range, 6-49 months), the narrowing of the spinal canal decreased progressively because of resorption of the fragments and natural remodeling. The presence of a neurologic deficit should be the primary indication for surgery in patients with a burst fracture of the lumbar spine.

Wire Fixation Technique for the Tibial Tubercle Osteotomy in Total Knee Arthroplasty

Purpose: The purpose of this study is to evaluate the clinical results of wire fixation technique for tibial tubercle osteotomy in total knee arthroplasty. Materials and Methods: Twenty-three cases who underwent TKA with tibial tubercle osteotomy and wire fixation technique for the extensile exposure between January, 1982 and April, 2001, were reviewed. Seventeen cases were male and six cases female. The average period of follow-up was 58 months. The average age was 62.3 years (minimal: 38, maximal: 74). Five cases underwent tibial tubercle osteotomy for primary TKA and the preoperative diagnoses were degenerative osteoarthritis in 2 cases, posttraumatic osteoarthritis in 1 case and rheumatoid arthritis in 2 cases. Eighteen cases underwent tibial tubercle osteotomy for revision TKA due to the infected TKA in 10 cases and aseptic loosening in 8 cases. Osteotomized tibial tubercle in size of cm was achieved by using oscillating saw and curved osteotome from the point of 2 cm distal to the articular surface of proximal tibia to 8 cm below the tibial tubercle. Six holes were drilled with 1 cm distance for 3 wires passage. The tubercle fragment was fixed with 3 wires and the wires were bent around the tibial stem in the medullary canal for passage through tubercle fragment. The passive range of motion was started within one week after the operation. We evaluated the preoperative and postoperative range of motion and the radiologic bony union was assessed by lateral radiograph. The clinical results were assessed by Knee Society Knee Score. Results: The bony union was achieved in twenty-two cases about 13 moths after the operation, and fixation loss was observed in one case. The average range of motion were postoperatively. The average clinical knee scores of pain and function were 51 (40-57) point, 58 (45-70) point preoperatively and 54 (50-65) point, 65 (54-78) point postoperatively. Two complications were noted with one case of infection and fixation loss due to injury in each. Conclusion: Wire fixation for tibial tubercle osteotomy in total knee arthroplasty results in firm fixation of tubercle fragment, therefore it seems to be an useful technique in exposure for total knee arthroplasty.