The incidence of atypical femoral fractures (AFFs) continues to increase. However, there are currently few long-term studies on the complications of AFFs and factors affecting them. Therefore, we attempted to investigate the outcomes, complications, and risk factors for complication through mid-term follow-up of more than three years. From January 2003 to January 2016, 305 patients who underwent surgery for AFFs at six hospitals were enrolled. After exclusion, a total of 147 patients were included with a mean age of 71.6 years (48 to 89) and 146 of whom were female. We retrospectively evaluated medical records, and reviewed radiographs to investigate the fracture site, femur bowing angle, presence of delayed union or nonunion, contralateral AFFs, and peri-implant fracture. A statistical analysis was performed to identify the significance of associated factors.Aims
Methods
The purpose of this study was to evaluate the relationships between the degree of injury to the medial and lateral collateral ligaments (MCL and LCL) and associated fractures in patients with a posterolateral dislocation of the elbow, using CT and MRI. We retrospectively reviewed 64 patients who presented between March 2009 and March 2018 with a posterolateral dislocation of the elbow and who underwent CT and MRI. CT revealed fractures of the radial head, coronoid process, and medial and lateral humeral epicondyles. MRI was used to identify contusion of the bone and collateral ligament injuries by tear, partial or complete tear.Aims
Methods
The aim of this study was to evaluate the clinical and radiological outcomes of locking plate fixation, with and without an associated fibular strut allograft, for the treatment of displaced proximal humeral fractures in elderly osteoporotic patients. We undertook a retrospective comparison of two methods of fixation, using a locking plate without an associated fibular strut allograft (LP group) and with a fibular allograft (FA group) for the treatment of these fractures. The outcome was assessed for 52 patients in the LP group and 45 in the FA group, with a mean age of 74.3 years (52 to 89), at a mean follow-up of 14.2 months (12 to 19). The clinical results were evaluated using a visual analogue scale (VAS) score for pain, the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and the range of movement. Radiological results were evaluated using the neck-shaft angle (NSA) and humeral head height (HHH).Aims
Patients and Methods
Periprosthetic joint infection (PJI) is one of the most devastating complications in patients undergoing total knee arthroplasty (TKA). Although controversy exists about the necessity of the prophylactic use of antibiotics in clean operations, the routine use of antibiotic-loaded bone cement (ALBC) has been the clinical procedure against PJI for many decades. Additionally, the combination of antibiotics has been used to broaden the antimicrobial spectrum and to enhance antimicrobial activity in a revision setting with a potentially resistant organism. Even in primary TKA, the prophylactic combination of antibiotics used as therapy should be considered on patients with a higher susceptibility to bacterial infection based on their clinical histories of PJI, rather than the lower risk population. The purpose of this study is to investigate whether the synergistic combination of antibiotics in bone cement in high risk patients can reduce PJI. A total of 3015 knees of 1918 patients were screened for inclusion in this study based on their risk factor, and those categorized as systematically or locally high risk patients were included. Patients that were classified as “systemically high risk” received an American Society of Anesthesiologists (ASA) classification of 3 or higher and a Charlson Comorbidity Index (CCI) classification of 2 or higher (n = 212 knees, 70.7% of 300 total). Patients that were classified as “locally high risk” had a history of inflammatory arthritis, poor skin conditions, and/or recent septic knee arthritis (n = 76 knees, 25.3%). Patients with both systemically and locally high risk included 12 knees (4.0%). The 300 knees included in this study were separated into three groups based on the combination of antibiotics administered. In group 1(208 knees), gentamycin–impregnated cement was used and in group 2(48 knees) hand-mixed vancomycin with pre-mixed gentamycin cement for intraoperative management was used. In group 3 revision bone cement containing a combination of two antibiotics (gentamycin and clindamycin) was used (44 knees). The mean age was 70.9 years. The number of men and women were 31(10.3%) and 269(89.7%), respectively. The average body mass index (BMI) was 26.7 kg/m2. The incidence of PJI was investigated.Background:
Methods:
Recently, patient expectations regarding the outcomes of total knee arthroplasty (TKA) have increase due to advances in knee implant design, surgical techniques, and procedure safety. However, outcomes do not always meet preoperative expectations. The purpose of this study is to investigate what Korean patients expect from their TKA and relationship between Pre-TKA expectation and demographic factors. We performed a prospective study of 228 patients undergoing primary TKA from April 2013 to May 2013. The number of men and women were 211 (92.5%) and 17 (7.5%) respectively, and mean age was 70.9. We used 19-item clinical knee assessment questionnaire including “crossed leg” item for unique sedentary culture in eastern countries. Each item was evaluated on a Likert scale from 0 to 4 (0: not relevant, 1: relevant, 2: little important, 3: somewhat important, 4: very important). We also used another questionnaire regarding to patient's demographics. Score of all expectation was calculated by sum of all item score.Introduction:
Methods:
Although minimally invasive plate osteosynthesis (MIPO) has become popular option for humeral shaft fractures, indirect reduction and its maintenance are technically challenging. The purpose of this study is to describe a reproducible technique utilizing an external fixator during MIPO and to assess its outcomes. Twenty-nine cases with a mean age of 37.1 years were included. There were 7 simple (type A) and 22 comminuted (type B or C) fractures. Indirect reduction was achieved and maintained by a monolateral external fixator on the lateral aspect of humeral shaft, and MIPO was performed on the anterior surface. Union, alignment, complications, and functional results of the shoulder and elbow were assessed.Background
Methods
Even in localized collapse due to osteonecrosis of the femoral head, a femoral head can be preserved by rotational osteotomy. In addition to anterior rotation, originally described by Sugioka, much more correction can be obtained by posterior rotation. But, transtrochanteric rotational osteotomy needs rather extensive soft tissue release, such as complete capsulotomy and resection of short external rotators and psoas tendons. Many patients tend to complain about the leg length discrepancy and limp due to varus change. We found soft tissue resection and limb shortening could be minimized by doing the osteotomy at the femur neck rather than the trochanteric area following the technique of surgical dislocation. It needs careful dissection of the posterior retinacular artery to preserve circulation to the femoral head. We have performed 17 cases (14 cases were in men and 3 cases were in women), and average patient age was 45 years old. Osteotomy was applied to cases with collapse or large necrotic region that seemed to be fail by core decompression. All cases showed collapse except one (ARCO 2-B) and 6 cases were ARCO 3-A, 5 cases were ARCO 3-B, 4 cases were ARCO 3-C and one case was ARCO stage 4. Seven cases were rotated anteriorly, and ten cases were rotated posteriorly. Amount of rotation was 63 to 170 degrees in posterior rotation (mean 100.8 degrees) and mean 48 degrees in anterior rotation. The size of the necrotic area was 301 degrees according to the Koo method (combined necrotic angle in mid-coronal and mid-saggital MRI scan).Introduction
Methods
We have evaluated the circulation of the femoral head after multiple pinning for femoral neck fractures by bone SPECT. Forty-four patients (33 women, 11 men, who had a mean age of 67 years) were enrolled prospectively. Early and late bone SPECT images were obtained on 2 to 13 days and 3 months after surgery and follow-up periods were over 12 months (average, 29 months).Introduction
Methods
