Soo Bong Hahn

Treatment of severe equinus deformity associated with extensive scarring of the leg

Nine severe equinus deformities of the foot associated with extensive scarring of the leg and ankle were corrected using a hinged Ilizarov apparatus and free-tissue transfer. The average duration of followup was 38 months (range, 28–54 months). Free tissue transfer was done in all patients; a parascapular flap was used in seven patients, and a groin flap was used in two patients. The results were evaluated using two objective criteria and one subjective assessment: the degree of active dorsiflexion, the range of active movement of the ankle, and daily activities. For active dorsiflexion of the ankle and activities, the results were good in seven patients and fair in two patients. For range of active motion of the ankle, the results were good in six patients and fair in two patients. One patient with ankle arthrodesis was excluded. This study showed that severe equinus deformities associated with extensive scarring of the leg and ankle can be corrected effectively with heel cord lengthening, free-tissue transfer, and a hinged Ilizarov technique.

Carpal Tunnel Syndrome Caused by Space Occupying Lesions

Purpose To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesions (SOL). Materials and Methods Eleven patients and 12 cases that underwent surgery for CTS due to SOL were studied retrospectively. We excluded SOL caused by bony lesions, such as malunion of distal radius fracture, volar lunate dislocation, etc. The average age was 51 years. There were 3 men and 8 women. Follow-up period was 12 to 40 months with an average of 18 months. The diagnosis of CTS was made clinically and electrophysiologically. In patients with swelling or tenderness on the area of wrist flexion creases, magnetic resonance imaging (MRI) and/or computed tomogram (CT) were additionally taken as well as the carpal tunnel view. We performed conventional open transverse carpal ligament release and removal of SOL. Results The types of lesion confirmed by pathologic examination were; tuberculosis tenosynovitis in 3 cases, nonspecific tenosynovitis in 2 cases, and gout in one case. Other SOLs were tumorous condition in five cases, and abnormal palmaris longus hypertrophy in 1 case. Tumorous conditions were due to calcifying mass in 4 cases and ganglion in 1 case. Following surgery, all cases showed alleviation of symptom without recurrence or complications. Conclusion In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and MRI and/or CT should be supplemented in order to rule out SOLs around the carpal tunnel, if necessary.

Prognostic factors and long-term outcomes following a modified Thompson’s quadricepsplasty for severely stiff knees

Between 1987 and 2006 we performed a modified Thompsons quadricepsplasty on 40 fracture-related stiff knees and followed the patients for a mean of 7.9 years (2 to 11.1). The factors affecting the final gain of movement were investigated. A total of 15 knees required lengthening of the rectus femoris. The mean flexion gain was 70.2 degrees (42.3 degrees to 112.5 degrees ). According to Judets criteria, the results were excellent in 30 knees, good in seven, and fair in three. The range of movement which was achieved intra-operatively was related to the gain of knee flexion on univariate analysis. Five patients had complications: deep infection in one, recurrent patellar dislocation in one, and rupture of the extensor mechanism in three. This modified technique gives satisfactory results. Achieving maximum knee flexion intra-operatively seems to be the most important factor in enhancing the outcome in patients with stiffness of the knee following fracture.

Decompression of the ulnar nerve and minimal medial epicondylectomy with a small incision for cubital tunnel syndrome: Comparison with anterior subcutaneous transposition of the nerve

UNLABELLED The objective of this study is to compare the results of ulnar nerve decompression and minimal medial epicondylectomy with a small incision (group I) and anterior subcutaneous transposition of the ulnar nerve (group II) for cubital tunnel syndrome. METHODS Out of 56 patients with cubital tunnel syndrome, 29 were in group I and 27 were in group II. The mean age at the time of the operation was 48.9 years, and the mean follow-up period was 36.4 months. Preoperatively, the neuropathy was graded according to Dellons criteria. RESULTS There were no significant differences between the results of the two groups according to the modified Bishops system at the last follow-up. However, four patients showed painful neuroma around the operation scar and one patient in group II had experienced acute deterioration of the symptoms after the procedure. CONCLUSIONS Decompression and minimal medial epicondylectomy with a small incision seems to be more recommendable than anterior subcutaneous transposition of the ulnar nerve for cubital tunnel syndrome in terms of its simplicity and lesser invasiveness.

Corrective dome osteotomy for cubitus varus and valgus in adults

A corrective dome osteotomy was performed in 19 adult patients for cubitus varus and valgus deformity. The mean age at operation was 31.1 years and the mean follow-up was 41 months. The average postoperative carrying angle in 16 patients with cubitus varus was 6.1 degrees (range, 1-10 degrees), an average correction of 24 degrees (range, 5-36 degrees). The average postoperative carrying angle in 3 patients with cubitus valgus was 6.7 degrees (range, 6-7 degrees), an average correction of 29.3 degrees (range, 29-30 degrees). None of the patients had recurrence of deformity, unsightly scarring, or a prominent lateral or medial condyle at final follow-up. An excellent result was achieved in 13 patients and good in 6. We conclude that corrective dome osteotomy with secure fixation using plates and screws is a reliable option for cubitus varus or valgus deformity in adults.

Lengthening of an amputation stump by the Ilizarov technique. A case report.

Summary. A woman, 29 years of age, sustained a below knee amputation following injury and was left with a stump 5.5 cm long. Good soft tissue cover was obtained with a myocutaneous flap using the gastrocnemius muscle and heel pad flap from the injured leg. The stump was then lengthened by 7 cm, to 12.5 cm, using the Ilizarov distraction technique. The patient was able to bear weight on the end of the fixator during the 8 months it was in position. The gap filled with bone and there were no complications. She recovered good function.Résumé. Les auteurs rapportent un cas d’amputation post-traumatique de la partie haute de jambe chez une femme de 29 ans. Le but de l’étude était d’évaluer le résultat de l’allongement du moignon d’amputation réalisé pour amèliorer l’ajustage d’une prothèse. Après échec par infection d’une greffe de l’extrêmité distale du tibia, le moignon était resté trop court pour permettre l’utilisation d’une prothèse conventionnelle. Les parties molles étaient restées suffisantes grâce à un lambeau muscolo-cutané utilisant le muscle jumeau et la coque talonnière. Bien qu’il y eut quelques problèmes de douleurs et d’inflammation sur les fiches, l’allongement osseux obtenu par la technique d’Ilizarov a été finalement un succès permettant une augmentation de longueur de 7 cms (127% d’augmentation). Pendant la période d’allongement, l’appui sur le membre inférieur a été possible.

A Comparison of Autologous and Homologous Transfusions in Spinal Fusion

Autologous transfusion has been used to overcome adverse effects of homologous transfusion. Clinical studies evaluating general orthopaedic postoperative results have been designed to compare these transfusion methods. However, few studies have evaluated postoperative results in spinal fusion surgeries, which have larger blood loss volumes. The purpose of this study is to determine if there are differences in postoperative infection and clinical results of spinal fusion with autologous, as compared to homologous, blood transfusion. A total of 62 patients who underwent instrumented spinal fusion and received autologous (n = 30) or homologous (n = 32) transfusions were reviewed. Information on gender, age, preoperative and 3-day postoperative hematologic features, total transfused units, segmental estimated blood loss, transfused units, and surgery time were collected. In addition, postoperative infection data on wound infection, pneumonia, urinary tract infection, cellulitis, and viral disease, incidence and duration of fever, as well as clinical results, fusion rates, and patient feedback were collected. No differences in postoperative infection and clinical results were found between the two types of transfusions; however, homologous transfusion was associated with an increased number of total units transfused, longer duration of fever, and decreased patient satisfaction regarding the transfusion.

Efficacy of Pre- and Postoperative Chemotherapy in Patients with Osteosarcoma of the Extremities.

PURPOSE We evaluated the treatment efficacy including survival and recurrence, and factors associated with recurrence in osteosarcoma patients treated with preoperative chemotherapy, surgery, and adjuvant chemotherapy. MATERIALS AND METHODS Forty nine patients with osteosarcoma were treated with preoperative chemotherapy with intra-arterial cisplatin and adriamycin infusion for 3 cycles, followed by surgery. According to the pathologic response, if tumor was necrotized more than 90%, the same adjuvant chemotherapy was reintroduced for 3 cycles, and if the response was not enough, then the salvage regimen was introduced. Plain chest film and chest CT scan were taken monthly and every 3 months, respectively. When tumor recurred, the metastasectomy was performed whenever possible. RESULTS Forty three patients were evaluable with amedian follow up of 53 months. Five-year disease-free and overallsurvival rate was 47.0% and 66.9%, respectively. The recurrence was observed in 22 patients (51.2%) with median time of 12.5 months. Baseline alkaline phosphatase (ALP) was the only significant factor for recurrence (p=0.03) and the patients with the possibility of metastasectomy recurrence showed higher post-relapse survival compared to other treatment modalities (26 momths vs 5~12 months). CONCLUSION These results indicates that pre- and postoperative chemotherapy with intra-arterial cisplatin and adriamycin infusion showed comparable treatment efficacy and acceptable toxicities.

Correction of long standing proximal interphalangeal flexion contractures with cross finger flaps and vigorous postoperative exercises.

Purpose We reviewed the results of cross finger flaps after surgical release and vigorous postoperative exercises for long-standing, severe flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers. Materials and Methods In 9 patients, all contracted tissue was sequentially released and the resultant skin defect was covered with a cross-finger flap. The cause of the contracture was contact burn in 4, skin graft in 3, and a previous operation in 2. The mean follow-up period was 41.2 months. Results The mean flexion contracture/further flexion in the joints were improved from 73.4/87.8° to 8.4/95.4° at the last follow-up. A mean of 19.5° of extension was achieved with vigorous extension exercise after the operation. The mean gain in range of motion (ROM) was 79.4°. Near full ROM was achieved in 3 cases. There were no major complications. Conclusions In severe flexion contractures with scarring of the PIP joints of fingers, cross finger flaps after sufficient release and vigorous postoperative exercise seems to be a reasonable option to obtain satisfactory ROM of the joints.

One-Bone Forearm Procedure for Acquired Pseudoarthrosis of the Ulna Combined with Radial Head Dislocation in a Child: A Case with 20 Years Follow-Up

This report describes a 6 year-old boy who was treated with one-bone forearm procedure for acquired pseudoarthrosis of the ulna combined with radial head dislocation after radical ulna debridement for osteomyelitis. At more than 20 years of follow-up, the patient had a nearly full range of elbow movements with a few additional surgical procedures. Pronation and supination was restricted by 45°, but the patient had near-normal elbow and hand functions without the restriction of any daily living activity. This case shows that one-bone forearm formation is a reasonable option for forearm stability in longstanding pseudoarthrosis of the ulna with radial head dislocation in a child.