Suk Kyu Choo

Ganglion cysts of the posterior cruciate ligament.

Ganglion cysts of the posterior cruciate ligament (PCL) are uncommon lesions found incidentally on MRI and arthroscopy. Twenty patients (11 males and nine females) with the mean age of 35 years presenting with a variety of knee signs and symptoms were found to have PCL cysts on MRI. Out of these, thirteen patients (65%) had isolated symptomatic PCL cysts and seven patients had associated chondral and meniscal lesions. Eight out of the 20 patients (40%) gave a history of antecedent trauma. On arthroscopy, the majority of the cysts were situated at the midsubstance of the ligament with inter-cruciate distension and no involvement of the substance of the ligament. The content of the cysts varied with the majority having yellowish viscous fluid and three containing serous and bloody fluid. All cysts were successfully treated arthroscopically through standard anterior, posteromedial and posterolateral portals with no signs of recurrence on MRI at a mean followup of 24 months. PCL cysts may clinically mimic meniscal or chondral lesions and preoperatively, MRI is essential for the diagnosis of ganglion cysts arising from the PCL. Ganglion cysts of the PCL can be successfully treated arthroscopically using standard portals.

Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing

BACKGROUND We present the surgical technique of separate vertical wiring for displaced inferior pole fractures of the patella combined with Krachow suture and report the surgical outcomes. MATERIALS AND METHODS Between September 2007 to May 2012, 11 consecutive patients (mean age, 54.6 years) with inferior pole fractures of the patella (AO/OTA 34-A1) were retrospectively enrolled in this study. Through longitudinal incision, all patients underwent open reduction and internal fixation by separate vertical wiring combined with Krackow suture. The range of motion, loss of fixation, and Bostman score were primary outcome measures. RESULTS The union time was 10 weeks after surgery on average (range: 8-12). No patient had nonunion, loss of reduction and wire breakage. There was no case of wound problem and irritation from the implant. At final follow-up, the average range of motion arc was 129.4° (range: 120-140). The mean Bostman score at last follow-up was 29.6 points (range: 28-30) and graded excellent in all cases. CONCLUSION Separate vertical wiring combined with Krackow suture for inferior pole fractures of the patella is a useful technique that is easy to perform and can provide stable fixation with excellent results in knee function.

Remote postconditioning attenuates ischemia/reperfusion injury in rat skeletal muscle through mitochondrial ATP-sensitive K+ channel-dependent mechanism.

The authors investigated whether a remote postconditioning (remote post-con) procedure attenuated skeletal muscle ischemia/reperfusion (I/R) injury. We determined the optimal protocol of remote post-con and investigated its mechanism. Ischemia was induced for 3 hours in rat left hindlimb and three protocols of remote post-con were applied in right hindlimb just before the end of ischemia. The first (10-second group) involved two cycles of 10 seconds of occlusion followed by 10 seconds of reperfusion. The second (5-minute group) involved two cycles of 5 minutes of occlusion/reperfusion. The third (10-minute group) involved two cycles of 10 minutes of occlusion/reperfusion. In 5- and 10-minute groups, wet/dry ratio and muscle fiber edema were significantly lower than control group. Muscle contractility was preserved in 5- and 10-minute groups. An injection of 5-hydroxydecanoate (a specific blocker of mitochondrial ATP-sensitive K+ [mKATP] channels) impaired this effect. This study demonstrates that remote post-con preserves muscle contractility and reduces tissue edema and necrosis, possibly through the activation of mKATP channels. We suggest that two cycles of 5 minutes of occlusion followed by 5 minutes of reperfusion are optimal protocols of remote post-con in skeletal muscle I/R injury.

Effectiveness of controlled telescoping system for lateral hip pain caused by sliding of blade following intramedullary nailing of trochanteric fracture

INTRODUCTION The purpose of this study was to demonstrate the effectiveness of controlled telescoping system for lateral hip pain caused by sliding of the blade following intramedullary nailing of trochanteric fractures. MATERIALS AND METHODS A retrospective cohort study was performed to compare the controlled telescoping system (Compression Hip Nail; CHN) with the conventional sliding system (Proximal Femoral Nail Antirotation; PFNA) for trochanteric fractures. 74 cases in the PFNA group and 77 cases in the CHN group were included from two university hospitals in this study. All patients had a minimum of 12-month follow up period. Lateral hip pain was evaluated and operation time and blood loss during the surgery were measured. The fracture classification was evaluated. The quality of postoperative reduction and other complications after surgery were also evaluated and tip-apex distance (TAD), telescoping and lateral protrusion of the blade and lag screw were measured. RESULTS The mean age was 78.5 years in the PFNA group and 74.7 years in the CHN group (p=0.25). The mean telescoping was 19.2mm in the PFNA group and 10.7mm in the CHN group (p<0.001). The mean length of lateral protrusion was 10.5mm in the PFNA group and 2.5mm in the CHN group (p<0.001). Twenty-eight patients in the PFNA group complained of lateral hip pain, whereas 12 patients in the CHN group did (p=0.002). These four variables showed statistically significant differences between the PFNA and CHN groups (p<0.05). The length of lateral protrusion was the only variable significantly related to lateral hip pain through multivariate logistic regression analysis (p=0.045). CONCLUSIONS The degree of lateral protrusion was mainly related to lateral hip pain. Therefore, controlled telescoping would help to decrease lateral hip pain by decreasing the lateral protrusion beyond the lateral femoral cortex.

Acute cholecystitis in elderly patients after hip fracture: Incidence and epidemiology.

Acute cholecystitis is a medical complication that can develop in the postoperative period after hip surgery. However, few studies have examined this complication in elderly patients. Our aim was therefore to evaluate the incidence and clinical manifestations of acute cholecystitis after hip fracture in elderly patients.

Conservative treatment after failure of internal fixation for periprosthetic femoral fractures: a report of two cases

Osteosynthesis using compression or locking plate following indirect fracture reduction and using a minimally invasive technique has been recommended for the surgical treatment of Vancouver B1 and C periprosthetic femoral fractures. Recent advancements in fracture healing emphasize the significance of the type of mechanical stability depending on fracture patterns and the importance of the preservation of the blood supply around the fracture sites. We report two cases of mechanical failure after internal fixation of periprosthetic femoral fractures despite adherence to the principles of fracture care. Both patients were treated conservatively with a thigh cuff cast due to other concurrent issues. Bone healing was successfully achieved in both cases as a result of the preservation of the tissues and the biology around the fractures during the initial operations. We present our experiences of conservative management together with the preservation of the biology around the fracture site, as viable alternative options for difficult and traumatic revision surgery in cases of failed periprosthetic fracture fixation procedures.