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ABSTRACT: BACKGROUND: We evaluated the integrity and functional outcomes of rotator cuff tear after performing the double-pulley suture bridge (DPSB) repair technique according to the tear size by using serial ultrasonographic examinations. MATERIALS AND METHODS: The study included 41 consecutive arthroscopic rotator repairs using the DPSB technique. The average follow-up was 28 months. We completed the serial ultrasonographic examinations and compared the results with the functional outcome using the American Shoulder and Elbow Surgeons (ASES) score, the Constant score, the Korean Shoulder Scoring (KSS) system, and the University of California, Los Angeles (UCLA) score. RESULTS: The overall retear rate was 19.5% (8 of 41), comprising 50% (2 of 4) for massive tears, 18% (2 of 11) for large tears, 17% (4 of 23) for medium tears, and no failures for small tears (0 of 3). The retear rate was 17.6% (6 of 34) after complete repair and 28.6% (2 of 7) after repair with gap formation. Seventy-five percent (6 of 8) of retears were identified within 6 months after operation and 25% (2 of 8) were identified more than 1 year after repair. The functional outcomes of the intact group and the retear group according to the ASES score, the Constant score, the KSS, and the UCLA score were 96, 93, 94, and 33, and 90, 82, 87, and 31, respectively (P > .05). CONCLUSION: The overall retear rate after DPSB repair was 19.5% with 2 time periods of retear. The outcome improved independent of the tear size and the cuff integrity.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 04/2012; · 1.93 Impact Factor
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ABSTRACT: Prolonged use of bisphosphonates in patients with osteoporosis reportedly induces femoral insufficiency fractures. However, the natural course of these fractures and how to treat them remain unknown.
We determined the rates of fracture displacement and subsequent operations of undisplaced insufficiency fractures of the femur in patients treated with prolonged bisphosphonate therapy.
We retrospectively collected and reviewed the clinical course of 11 patients (14 fractures) who had been diagnosed as having an insufficiency fracture of the femur after prolonged use (mean, 4.5 years; range, 3-10 years) of bisphosphonate. All patients were women with a mean age of 68 years (range, 57-82 years). The fracture site was subtrochanteric in six and femoral shaft in eight. The minimum followup was 12 months (mean, 27 months; range, 12-60 months).
During the followup period, secondary displacement of the fracture occurred in five of the 14 fractures after a mean of 10 months (range, 1-19 months). Three fractures were treated with internal fixation using a compression hip screw and two with intramedullary nailing. Because five additional fractures were treated surgically owing to intractable pain, surgery was performed in 10 of 14 insufficiency fractures during the followup period. All 10 fractures healed during followup. The remaining four patients (four fractures) not undergoing any surgery had persistent pain.
Femoral insufficiency fractures after prolonged bisphosphonate therapy seldom healed spontaneously and most patients had surgery either for fracture displacement or persistent pain.
Clinical Orthopaedics and Related Research 12/2010; 468(12):3393-8. · 2.53 Impact Factor
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ABSTRACT: The authors studied the short-term outcomes of total hip arthroplasty (THA) performed using large diameter femoral heads or bipolar arthroplasty (BA) in physiologically active elderly patients with displaced intracapsular femoral neck fractures. The THA group included 14 males and 66 females with a mean age of 75.5 years, and the BA group included 16 males and 73 females with a mean age of 77.6 years. Surgical procedures were performed by one surgeon using a modified Hardinge approach. Mean operation times were significantly longer in the THA groups. Pain, mobility, and walking ability scores were significantly better in the THA group than in the BA group. Despite no range of motion limitation during the early postoperative period, no dislocation was encountered in either group. The present study suggests that for displaced femoral neck fractures, THA with a large diameter femoral head results in less pain and better function than BA.
The Journal of arthroplasty 03/2010; 26(6):893-6. · 1.79 Impact Factor
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ABSTRACT: This study was performed to estimate the prevalence of osteonecrosis of the femoral head in Korea. Using medical claims data from the Korean National Health Insurance Corporation, all individuals treated under a diagnosis of osteonecrosis of the femoral head were identified for each year from 2002 to 2006. Among them, the number of true cases was estimated using a randomly collected validation sample of 382 patients for which the actual diagnosis was investigated by authors. The estimated yearly prevalence per 100 000 population ranged from 20.53 (20.13 <or= 95% confidence interval <or= 20.94) in 2002 to 37.96 (37.42 <or= 95% confidence interval <or= 38.51) in 2006. The average estimated number of annual prevalent cases was 14 103, indicating 28.91 per 100 000 average prevalence over a 5-year period. Males predominated. We found that 32.4% had history of alcohol abuse, and 14.6% was related to steroid. Bilateral involvement was noticed in 37%. Besides arthroplasty, decompression was the most frequently performed joint-preserving procedure. We believe that the results serve as important baseline for understanding the disease.
The Journal of arthroplasty 07/2009; 24(8):1178-83. · 1.79 Impact Factor
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The Journal of the Korean Orthopaedic Association 01/2009; 44(5).
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ABSTRACT: The reverse obliquity fracture of the proximal femur (AO/OTA 31-A3) is mechanically different from most intertrochanteric fractures. The purpose of this study was to compare the results of proximal femoral nail (PFN) fixation with those of gamma nail (GN) fixation for these fractures.
Between 1993 and 2003, 635 of the fractures were classified as intertrochanteric or subtrochanteric. Clinical and radiographic records were retrospectively reviewed, and 22 fractures with reverse obliquity pattern were identified. The patients were divided into two treatment groups and were followed up for a minimum of 1 year (range, 12-67 months). Eleven patients in group I were treated with the PFN, and 11 patients in group II were treated with the GN. The two groups were comparable with regard to demographic and injury variables. The duration of follow-up averaged 18 months (range, 12-67 months). Radiographic changes during the follow-up, clinical outcome, and complications of the PFN group were compared with those of the GN group.
Reverse obliquity intertrochanteric fractures accounted for 4.3% of intertrochanteric and subtrochanteric fractures. Bone union time averaged 16.5 weeks in the PFN group and 17.9 weeks in the GN group. Average sliding of lag screw was 2.5 mm in the PFN group and 3.1 mm in the GN group (p = 0.046). Change of the neck-shaft angle was 2.45 degrees in the PFN group and 3.75 degrees in the GN group (p = 0.032). A satisfactory functional outcome was found in eight patients in the PFN group and also in eight patients in the GN group. There was one osteonecrosis of femoral head in the PFN group. There was one cutting out of lag screw, one nonunion, and one varus deformity in the GN group.
There was no difference in clinical outcome between the PFN and GN groups. However, the PFN demonstrated better results biomechanically than the GN did in terms of less sliding of lag screw, less change of neck-shaft angle, and less complications for the treatment of reverse obliquity intertrochanteric fractures.
The Journal of trauma 12/2007; 63(5):1054-60. · 2.48 Impact Factor
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ABSTRACT: To examine the validity of bleeding from the drill holes used for cannulated screw placement as a method for predicting any subsequent avascular necrosis of the femoral head (AVNFH) after the fixation of intracapsular femoral neck fractures.
Retrospective study.
University hospital.
Forty-four patients (mean age, 51 years; range, 18-76 years) whose femoral neck fractures had been fixed with cannulated screws from March 1999 to January 2001 were enrolled in this study. The fractures were classified according to Garden and included 11 type I, 5 type II, 17 type III, and 11 type IV. The average delay between injury and surgery was 52 hours (< or =24 hours, 26; > or =24 hours, 18; range 7 to 504 hours). The follow-up period was more than 25 months (range, 25-57 months).
7.0 mm cannulated screws were used for fracture fixation. Three and 4 screws were used for fixation in 35 and 9 cases, respectively.
The presence or absence of blood drainage from the holes of the proximal cannulated screws was determined by an independent observer and defined as bleeding or no bleeding throughout a 5 minute observation period. According to those findings, patients were classified into 2 groups: the bleeding group (38 cases), and the nonbleeding group (6 cases). The validity of the relationship between the 2 groups and the development of AVNFH was evaluated according to the sensitivity, specificity, positive predictive value, and negative predictive value. A chi test was used for univariate analysis of the relationship between the related factors with the development of AVNFH.
The mean follow-up was 39 months (range, 25-57 months). AVNFH developed in 7 cases (16%). One patient of 38 in the bleeding group (2.6%) and all 6 patients in the nonbleeding group (100%) developed AVNFH. The sensitivity was 86%, specificity 100%, positive predictive value 100%, and negative predictive value 97%. Age (P < 0.734), sex (P < 0.587), the type of the fracture (P < 0.356), procedure interval (P < 0.398), the reduction status of the fracture site (P < 0.3849), the positions of the fixed screws (P < 0.2137), and the existence of osteoporosis (P < 0.4347) were not related to the development of AVNFH.
It seems that bleeding from the holes of proximal cannulated screws is a simple and accurate perfusion assessment technique for predicting the development of AVNFH after a femoral neck fracture. Given that assumption, primary arthroplasty might be an appropriate choice as a treatment method in a nonbleeding-group patient whose treatment choice is ambivalent or who might not be able to undergo additional surgery should he or she develop a subsequent AVNFH after internal fixation of femoral neck fracture.
Journal of Orthopaedic Trauma 04/2007; 21(3):158-64. · 2.13 Impact Factor
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ABSTRACT: We retrospectively analyzed the prognostic factors related to the failure of acetabular components after total hip arthroplasties in radiated hips. Eighteen hips from 12 patients who had primary arthroplasties were followed up for a mean of 58 months (range, 20-139 months). The patients' age, total radiation dose, latent period, presence of infection, and the type of the acetabular component were examined as possible predictors of failure using the Cox proportional hazard regression. Multivariate analyses showed that a longer latent period was the most important risk factor for failure, increasing 1.72 times when the latent period was greater than 1 year, after adjusting for other predictors. The latent period might be helpful for clinicians in choosing a treatment method for patients. LEVEL OF EVIDENCE: Prognostic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 10/2005; 438:165-70. · 2.53 Impact Factor
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ABSTRACT: Durable results of total hip arthroplasty have been difficult to achieve in young patients. We reviewed the intermediate-term clinical and radiographic results in a series of active, higher-demand patients who were less than fifty years old when they underwent cementless total hip arthroplasty with the use of the Metasul metal-on-metal articulation.
Seventy total hip arthroplasties were performed in sixty-two patients who were younger than fifty years of age (average age, thirty-seven years). Two patients (two hips) had had a resection arthroplasty because of deep infection less than five years postoperatively and were excluded. Sixty patients (sixty-eight hips) were available for complete clinical and radiographic analysis after a mean duration of follow-up of seven years.
The mean preoperative Harris hip score of 49 points improved to 95 points at the time of final follow-up; fifty-six patients (93%) had an excellent result. No component was seen to be loose radiographically at the time of final follow-up. Only one focal area of pelvic osteolysis in one patient and two small focal areas of femoral osteolysis in another patient were identified. The hip with focal pelvic osteolysis underwent revision surgery with a liner change and bone-grafting of the osteolytic lesion around a stable component.
At a mean of seven years after arthroplasties with a Metasul metal-on-metal articulation, there was a low rate of osteolysis and aseptic loosening in this group of young patients. However, additional follow-up is necessary to determine any possible long-term deleterious effects associated with this metal-on-metal articulation.
The Journal of Bone and Joint Surgery 12/2004; 86-A(11):2475-81. · 3.27 Impact Factor
